Systems and methods for heart valve therapy

ABSTRACT

Prosthetic heart valves described herein can be deployed using a transcatheter delivery system and technique to interface and anchor in cooperation with the anatomical structures of a native heart valve. Deployment systems and methods for using the deployment systems described herein facilitate accurately and conveniently controllable percutaneous, transcatheter techniques by which the prosthetic heart valves can be delivered and deployed within a patient.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application Ser.No. 62/205,355, filed Aug. 14, 2015. The disclosure of the priorapplication is considered part of (and is incorporated by reference in)the disclosure of this application.

TECHNICAL FIELD

This document relates to prosthetic heart valves, such as prostheticmitral valves that can be implanted using transcatheter techniques. Thisdocument also relates to systems for actuating and controlling thepercutaneous deployment of prosthetic mitral valves using transcathetertechniques.

BACKGROUND

The long-term clinical effect of valve regurgitation is recognized as asignificant contributor to cardiovascular related morbidity andmortality. Thus, for many therapies intended to treat the mitral valve,one primary goal is to significantly reduce or eliminate regurgitation.By eliminating the regurgitation at the mitral valve, the destructivevolume overload effects on the left ventricle can be attenuated. Thevolume overload of mitral regurgitation (MR) relates to the excessivekinetic energy required during isotonic contraction to generate overallstroke volume in an attempt to maintain forward stroke volume andcardiac output. It also relates to the pressure potential energydissipation of the leaking valve during the most energy-consumingportion of the cardiac cycle, isovolumetric contraction. Additionally,therapies for MR reduction can have the effect of reducing the elevatedpressures in the left atrium and pulmonary vasculature reducingpulmonary edema (congestion) and shortness of breath symptomatology.Such therapies for MR reduction may also have a positive effect on thefilling profile of the left ventricle (LV) and the restrictive LVphysiology that can result with MR. These pathophysiologic issuesindicate the potential benefits of MR therapy, but also indicate thecomplexity of the system and the need for a therapy to focus beyond theMR level or grade.

In some percutaneous access procedures in which a medical device isintroduced through a patient's skin and into a patient's blood vessel,such an access can be used to introduce devices into the patient withoutthe use of large cut downs, which can be painful and in some cases canhemorrhage or become infected. A percutaneous access generally employsonly a small hole through the skin, which subsequently seals relativelyeasily, and heals quickly in comparison to a surgical cut down.

SUMMARY

This document describes prosthetic heart valves, such as prostheticmitral valves, that interface and anchor in cooperation with theanatomical structures of a native mitral valve. In addition, thisdocument describes multiple embodiments of medical device deliverysystems, for example, to deliver a prosthetic heart valve or othermedical device through a patient's vasculature, and also describesmethods for percutaneous, transcatheter delivery and deployment ofmedical devices including, but not limited to, prosthetic heart valves.

In some implementations, a prosthetic mitral valve and deployment systemincludes a prosthetic mitral valve system, a system of multiplecatheters configured to deliver the prosthetic mitral valve system, anda deployment frame system. At least some catheters of the multiplecatheters are slidably engageable with each other. At least a firstcatheter of the multiple catheters is releasably coupleable to theprosthetic anchor assembly. At least a second catheter of the multiplecatheters is releasably coupleable to the prosthetic valve assembly. Theprosthetic mitral valve system can include a prosthetic anchor assemblycomprising an anchor frame that defines an interior space, and aprosthetic valve assembly comprising a valve frame and multiple valveleaflets attached to the valve frame. The valve frame is configured toreleasably couple with the prosthetic anchor assembly within theinterior space. The deployment frame includes a plurality of clamps, afirst frame, and a second frame. Each clamp of the plurality of clampsis configured to releasably clamp a proximal end portion of a respectivecatheter of the multiple catheters. Each clamp of the plurality ofclamps is configured to releasably couple with the first frame. At leastone clamp of the plurality of clamps is configured to releasably couplewith the second frame.

Such a prosthetic mitral valve and deployment system may optionallyinclude one or more of the following features. The prosthetic anchorassembly may include a hub attached to the anchor frame. In someembodiments, the first catheter is releasably coupleable to the hub. Oneor more control wires may releasably couple the second catheter to theprosthetic valve assembly. Each clamp of the plurality of clamps may beconfigured to slidably engage with the first frame. The at least oneclamp of the plurality of clamps may be configured to slidably engagewith the second frame. The at least one clamp of the plurality of clampsmay be configured to slidably engage with the first frame and with thesecond frame. Each catheter that is releasably clamped to a clamp may berotatable, in relation the clamp, about a longitudinal axis of thecatheter. Two or more clamps of the plurality of clamps may beconfigured to releasably couple with the second frame. The two or moreclamps of the plurality of clamps may be lockable to the second frameand unlockable from the first frame such that a translational movementof the second frame simultaneously moves the two or more clamps of theplurality of clamps in relation to the first frame. The translationalmovement of the second frame may cause corresponding simultaneousmovements of two or more catheters of the multiple catheters.

In another implementation, a method of implanting a prosthetic mitralvalve in a patient includes: (a) inserting, into the patient, a systemof multiple catheters configured to deliver the prosthetic mitral valve;(b) engaging, to a deployment frame system, the system of multiplecatheters; and (c) manipulating the deployment frame system to implantthe prosthetic mitral valve in the patient. The deployment frame systemmay include a plurality of clamps, a first frame, and a second frame. Atleast one clamp of the plurality of clamps is configured to releasablycouple with the second frame. Each clamp of the plurality of clampsconfigured to releasably clamp a proximal end portion of a respectivecatheter of the multiple catheters. Each clamp of the plurality ofclamps is configured to releasably couple with the first frame.

Such a method of implanting a prosthetic mitral valve in a patient mayoptionally include one or more of the following features. Themanipulating the deployment frame system may include a translationalmovement of the second frame in relation to the first frame. Two or moreclamps of the plurality of clamps may be releasably coupled with thesecond frame. In some embodiments, the translational movement of thesecond frame causes simultaneous movements of two or more catheters ofthe multiple catheters. The manipulating the deployment frame system mayinclude rotating at least one catheter of the multiple catheters about alongitudinal axis of the at least one catheter, and in relation to aclamp with which the at least one catheter is releasably clamped.

In another implementation, a medical device deployment system includes asystem of multiple catheters configured to deliver a medical device anda deployment frame system. At least some catheters of the multiplecatheters are slidably engageable with each other. At least one catheterof the multiple catheters is releasably coupleable with the medicaldevice. The deployment frame system includes: (i) a plurality of clamps,each clamp of the plurality of clamps configured to releasably clamp aproximal end portion of a respective catheter of the multiple catheters;(ii) a first frame, wherein at least two clamps of the plurality ofclamps are configured to releasably couple with the first frame; and(iii) a second frame, wherein at least one clamp of the plurality ofclamps is configured to releasably couple with the second frame.

Such a medical device deployment system may optionally include one ormore of the following features. One or more control wires may be used toreleasably couple the at least one catheter with the medical device.Each clamp of the plurality of clamps may be configured to slidablyengage with the first frame. The at least one clamp of the plurality ofclamps may be configured to slidably engage with the second frame. Theat least one clamp of the plurality of clamps may be configured toslidably engage with the first frame and with the second frame. Eachcatheter that is releasably clamped to a clamp may be rotatable, inrelation the clamp, about a longitudinal axis of the catheter. Two ormore clamps of the plurality of clamps may be configured to releasablycouple with the second frame. The two or more clamps of the plurality ofclamps may be lockable to the second frame and unlockable from the firstframe such that a translational movement of the second framesimultaneously moves the two or more clamps of the plurality of clampsin relation to the first frame. The translational movement of the secondframe may cause corresponding simultaneous movements of two or morecatheters of the multiple catheters.

In another implementation, a deployment frame system for controllingrelative movements of a system of multiple catheters wherein at leastone catheter of the multiple catheters is configured to deliver amedical device includes: (1) a plurality of clamps, each clamp of theplurality of clamps configured to releasably clamp a proximal endportion of a respective catheter of the multiple catheters; (2) a firstframe, wherein at least two clamps of the plurality of clamps areconfigured to releasably couple with the first frame; and (3) a secondframe, wherein at least one clamp of the plurality of clamps isconfigured to releasably couple with the second frame.

In another implementation, a prosthetic mitral valve and deploymentsystem includes a prosthetic mitral valve, a system of multiplecatheters configured to deliver the prosthetic mitral valve, and adeployment frame system. At least some catheters of the multiplecatheters are slidably engageable with each other. One or more cathetersof the multiple catheters are releasably coupleable to the prostheticmitral valve. The deployment frame system includes a plurality ofclamps, a first frame, and a second frame. Each clamp of the pluralityof clamps is configured to releasably clamp a proximal end portion of arespective catheter of the multiple catheters. Each clamp of theplurality of clamps is configured to releasably couple with the firstframe. At least one clamp of the plurality of clamps is configured toreleasably couple with the second frame.

Such a prosthetic mitral valve and deployment system may optionallyinclude one or more of the following features. The prosthetic mitralvalve may include a hub, and the first catheter may be releasablycoupleable to the hub. One or more control wires may releasably couplethe second catheter to the prosthetic mitral valve. Each clamp of theplurality of clamps may be configured to slidably engage with the firstframe. The at least one clamp of the plurality of clamps may beconfigured to slidably engage with the second frame. The at least oneclamp of the plurality of clamps may be configured to slidably engagewith the first frame and with the second frame. Each catheter that isreleasably clamped to a clamp may be rotatable, in relation the clamp,about a longitudinal axis of the catheter. Two or more clamps of theplurality of clamps may be configured to releasably couple with thesecond frame. The two or more clamps of the plurality of clamps may belockable to the second frame and unlockable from the first frame suchthat a translational movement of the second frame simultaneously movesthe two or more clamps of the plurality of clamps in relation to thefirst frame. The translational movement of the second frame may causecorresponding simultaneous movements of two or more catheters of themultiple catheters.

In another implementation, a method of implanting a prosthetic mitralvalve in a patient includes: inserting, into the patient, a system ofmultiple catheters configured to deliver the prosthetic mitral valve;engaging, to a deployment frame system, the system of multiplecatheters; and manipulating the deployment frame system to implant theprosthetic mitral valve in the patient. The prosthetic mitral valveincludes an anchor assembly and a valve assembly that is configured tocouple with the anchor assembly. The deployment frame system includes aplurality of clamps, a first frame, and a second frame. Each clamp ofthe plurality of clamps is configured to releasably clamp a proximal endportion of a respective catheter of the multiple catheters. Each clampof the plurality of clamps is configured to releasably couple with thefirst frame. At least one clamp of the plurality of clamps is configuredto releasably couple with the second frame.

Some or all of the embodiments described herein may provide one or moreof the following advantages. First, the transcatheter prosthetic heartvalve deployment systems described herein are configured to facilitateaccurate control of the catheter systems and prosthetic valve componentsduring the delivery and deployment process. In some embodiments,proximal-end controls of the delivery system catheters are mounted to astable base in relation to the patient, and mounted in a manner thatallows for isolated, accurate movements of each degree of freedomassociated with the catheters and prosthetic valve components.Accordingly, relatively complex catheter and/or valve componentmovements are facilitated in an accurately controllable anduser-convenient manner. In result, transcatheter implant procedures canbe performed with enhanced patient safety and treatment effectivenessusing the deployment systems described herein.

Second, some embodiments of the transcatheter prosthetic heart valvedeployment systems described herein are configured to facilitatesimultaneous movement of two or more components of the deploymentsystem, corresponding to two or more movements of the catheter deliverysystem. For example, as described further below, some embodiments of thetranscatheter prosthetic heart valve deployment systems include twoframes (e.g., a main frame and a secondary frame) that facilitate suchsimultaneous movements. In result, relatively complex movements of twoor more components simultaneously, can be readily performed using thetranscatheter prosthetic heart valve deployment systems and methodsdescribed herein.

Third, some embodiments of the prosthetic mitral valve systems providedherein can be used in a completely percutaneous/transcatheter mitralreplacement procedure that is safe, reliable, and repeatable by surgeonsand/or interventional cardiologists of a variety of different skilllevels. For example, in some implementations the prosthetic mitral valvesystem can establish a reliable and consistent anchor/substrate to whichthe valve/occluder structure subsequently engages. Thus, the prostheticmitral valve system can be specifically designed to make use of thegeometry/mechanics of the native mitral valve to create sufficientholding capability. In one particular aspect, the anatomical gutterfound below a native mitral valve annulus can be utilized as a site foranchoring the prosthetic mitral valve system, yet the anchoringstructure can be deployed in a matter that maintains native leafletfunction of the mitral valve, thereby providing the ability tocompletely separate and stage the implantation of the components of theprosthetic mitral valve system. Accordingly, some embodiments of theprosthetic mitral valve systems described herein are configured to beimplanted in a reliable, repeatable, and simplified procedure that isbroadly applicable to a variety of patients and physicians, while alsoemploying a significantly less invasive method.

Fourth, in particular embodiments, the prosthetic mitral valve systemcan include two different expandable components (e.g., an anchorassembly and a valve assembly) that are separately delivered to theimplantation site, and both components can abut and engage with nativeheart tissue at the mitral valve. For example, the first component(e.g., the anchor assembly) can be configured to engage with the hearttissue that is at or proximate to the annulus of the native mitralvalve, and the second component (e.g., the valve assembly) can beconfigured to provide a seal interface with native valve leaflets of themitral valve.

Fifth, using the devices, systems, and methods described herein, variousmedical conditions, such as heart valve conditions, can be treated in aminimally invasive fashion. Such minimally invasive techniques can tendto reduce recovery times, patient discomfort, and treatment costs.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is a perspective view of a portion of a prosthetic mitral valvedeployment system in a cross-sectional view of a native human heart, inaccordance with some embodiments.

FIG. 2 shows a perspective view of a prosthetic mitral valve anchorassembly in the left atrium of the heart after the anchor assembly hasemerged from an anchor delivery sheath of the deployment system of FIG.1

FIG. 3 shows a perspective view of the anchor assembly of FIG. 2 afterbeing rotated/panned in the left atrium so as to orient the anchorassembly generally perpendicular to the native mitral valve.

FIG. 4 shows a perspective view of the anchor assembly of FIG. 3 afterbeing partially advanced through the native mitral valve so as toposition projections of the anchor assembly below a sub-annular gutterof the native mitral valve.

FIG. 5 shows a perspective view of the anchor assembly in a similararrangement as shown in FIG. 4, but in a commissural cross-sectionalview of the heart (from the left side of the heart).

FIG. 6 shows a perspective view of the anchor assembly of FIG. 5 afterbeing retracted so as to position the projections of the anchor assemblyin the sub-annular gutter of the native mitral valve.

FIG. 7 shows a perspective view of the anchor assembly of FIG. 6 afterthe retraction of some members of the deployment system.

FIG. 8 is a top view of a native mitral valve and depicts a gutterperimeter of the sub-annular gutter of FIG. 7 (without the anchorassembly).

FIG. 9 shows a perspective top view of an example anchor assembly ofFIGS. 2-7, including an example SAM containment member in a pre-deployedconfiguration, in accordance with some embodiments.

FIG. 10 shows a perspective top view of the example anchor assembly ofFIG. 9, with the SAM containment member is a deployed configuration, inaccordance with some embodiments.

FIG. 11 shows a perspective top view of an example anchor assembly,including another example SAM containment member in a deployedconfiguration, in accordance with some embodiments.

FIG. 12 shows a perspective top view of the anchor assembly of FIG. 10with a covering material disposed on portions of the anchor frame.

FIG. 13A shows a perspective top view of the anchor assembly of FIG. 10implanted within a native mitral valve (with the native mitral valveleaflets in a closed state), and FIG. 13B shows a correspondinganatomical top view of the anchor assembly of FIG. 13A.

FIG. 14A shows a perspective top view of the anchor assembly of FIG. 10implanted within the native mitral valve of FIG. 13A (with the nativemitral valve leaflets in an open state), and FIG. 14B shows acorresponding anatomical top view of the anchor assembly of FIG. 14A.

FIG. 15 shows a perspective view of the anchor assembly of FIG. 7implanted within the native mitral valve and a valve assembly deliverysheath extending into the left atrium.

FIG. 16 shows a perspective view of a valve assembly in the left atriumafter partial emergence from the valve assembly delivery sheath of FIG.15. The valve assembly is configured in a first (partially expanded)arrangement.

FIG. 17 shows a perspective view of the valve assembly of FIG. 16 withthe valve deployment system being manipulated in preparation for theinstallation of the valve assembly into the anchor assembly.

FIG. 18 shows a perspective view of the valve assembly of FIG. 17 (whilestill in the first (partially expanded) arrangement) being positionedwithin the anchor assembly.

FIG. 19 shows a perspective view of the valve assembly of FIG. 18, withthe valve assembly expanded within the anchor assembly and detached fromthe deployment system, but prior to deployment of the SAM containmentmember.

FIG. 20 shows an anterior side view of a valve frame of a valve assemblyof FIGS. 16-19, in accordance with some embodiments.

FIG. 21 shows a bottom view of the valve frame of FIG. 20.

FIG. 22 is an exploded posterior side view of an anchor assembly andvalve assembly of FIGS. 16-19, in accordance with some embodiments.

FIG. 23 is a top view of an example prosthetic mitral valve system thatincludes a valve assembly engaged with an anchor assembly, in accordancewith some embodiments.

FIG. 24 is a bottom view of the example prosthetic mitral valve systemof FIG. 23.

FIG. 25 shows a top view of the prosthetic mitral valve system of FIG.23 implanted within a native mitral valve. The occluder portion ofprosthetic mitral valve system is shown in a closed state.

FIG. 26 shows a top view of the prosthetic mitral valve system of FIG.23 implanted within a native mitral valve. The occluder portion of theprosthetic mitral valve system is shown in an open state.

FIG. 27 shows a perspective view of a patient on an operating tableundergoing a percutaneous deployment of an implantable prosthetic usinga deployment frame system in accordance with some embodiments.

FIG. 28A shows a perspective view of an example deployment frame systemconfiguration in accordance with some embodiments.

FIGS. 28B and 28C show enlarged views of portions of the deploymentframe system of FIG. 28A.

FIGS. 29A and 29B are schematic depictions of a catheter system anddeployment frame system which illustrate the movement of an individualcatheter system component.

FIGS. 30A and 30B are schematic depictions of a catheter system anddeployment frame system which illustrate the movement of a group ofcatheter system components in unison with each other.

FIG. 31 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

FIG. 32 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

FIG. 33 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

FIG. 34 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

FIG. 35 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

FIG. 36 shows a perspective view of another example deployment framesystem configuration in accordance with some embodiments.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

This disclosure describes embodiments of a prosthetic heart valvesystem, such as prosthetic mitral valve systems, and transcathetersystems and methods for implanting prosthetic heart valve systems. Insome embodiments, the prosthetic mitral valve system can be deployed tointerface and anchor in cooperation with the native anatomicalstructures of a mitral valve (and, optionally, in a manner that permitsthe continued natural function of the chordae tendineae of the nativemitral valve leaflets even after the anchor component is deployed). Asdescribed in more detail below, FIGS. 1-26 describe prosthetic mitralvalves, and transcatheter mitral valve delivery systems and methods bywhich the prosthetic mitral valves can be deployed to interface andanchor in cooperation with the anatomical structures of a native mitralvalve. Also, in FIGS. 27-36, multiple deployment frame systemembodiments and methods for using the deployment frame systems aredescribed by which the prosthetic mitral valves described herein can bedelivered and deployed within a patient using percutaneous,transcatheter techniques.

Referring to FIG. 1, an example transcatheter mitral valve deliverysystem 100 can be navigated through a patient's vasculature to obtainaccess to the patient's heart 10. The transcatheter delivery system 100facilitates implantation of a prosthetic mitral valve in a beating heart10 using a percutaneous, or minimally invasive technique (withoutopen-chest surgery or open-heart). For example, in some implementationsthe transcatheter delivery system 100 is percutaneously inserted into afemoral or iliac vein via a groin opening/incision 2 in a patient 1(FIG. 27) using a deployment frame system 6 (FIGS. 1 and 27) configuredto activate and/or control the movements of various components of thetranscatheter delivery system 100. In some implementations, thetranscatheter delivery system 100 is used in conjunction with one ormore imaging modalities such as x-ray fluoroscopy, echocardiography,magnetic resonance imaging, computed tomography (CT), and the like.

The heart 10 (depicted in cross-section from a posterior perspective inFIG. 1) includes a right atrium 12, a right ventricle 14, a left atrium16, and a left ventricle 18. A tricuspid valve 13 separates the rightatrium 12 from the right ventricle 14. A mitral valve 17 separates theleft atrium 16 from the left ventricle 18. An atrial septum 15 separatesthe right atrium 12 from the left atrium 16. An inferior vena cava 11 isconfluent with the right atrium 12. It should be understood that thisdepiction of the heart 10 is somewhat stylized. The same is true forFIGS. 2-4. FIGS. 1-4 provide general depictions of the approach to themitral valve 17 that is used in some implementations. But, thecommissural cross-sectional views of FIG. 5 and thereafter moreaccurately depict the orientation of the prosthetic mitral valves inrelation to the heart 10.

Still referring to FIG. 1, in the depicted embodiment, the deliverysystem 100 includes a guidewire 110, a guide catheter 120, and an anchordelivery sheath 130. Additional components of the delivery system 100will be described further below. The anchor delivery sheath 130 isslidably (and rotationally) disposed within a lumen of the guidecatheter 120. The guidewire 110 is slidably disposed with respect to alumen of the anchor delivery sheath 130. In this depiction, the anchordelivery sheath 130 has been partially extended relative to the guidecatheter 120, allowing a flared portion 132 to expand outward, asdescribed further below.

In the depicted implementation, the guidewire 110 is installed into theheart 10 prior to the other components of the delivery system 100. Insome embodiments, the guidewire 110 has a diameter of about 0.035 inches(about 0.89 mm). In some embodiments, the guidewire 110 has a diameterin a range of about 0.032 inches to about 0.038 inches (about 0.8 mm toabout 0.97 mm). In some embodiments, the guidewire 110 has a diametersmaller than 0.032 inches (about 0.80 mm) or larger than 0.038 inches(about 0.97 mm). In some embodiments, the guidewire 110 is made ofmaterials such as, but not limited to, nitinol, stainless steel,high-tensile-strength stainless steel, and the like, and combinationsthereof. The guidewire 110 may include various tip designs (e.g., J-tip,straight tip, etc.), tapers, coatings, covers, radiopaque (RO) markers,and other features. In some embodiments, the guidewire 110 has one ormore portions with differing lateral stiffnesses, column strengths,lubricity, and/or other physical properties in comparison to otherportions of the guidewire 110.

In some implementations, the guidewire 110 is percutaneously insertedinto a femoral vein of the patient. The guidewire 110 is routed to theinferior vena cava 11 and into the right atrium 12. After creating anopening in the atrial septum 15 (e.g., a trans-septal puncture of thefossa ovalis or other portion of the atrial septum), the guidewire 110is routed into the left atrium 16. Lastly, the guidewire 110 is routedthrough the mitral valve 17 and into the left ventricle 18. This ispreferably performed without entangling the guidewire 110 with thechordae tendineae of the mitral valve 17. In some implementations, theguidewire 110 can be installed into the heart 10 along other anatomicalpathways. The guidewire 110 thereafter serves as a rail over which othercomponents of the delivery system 100 are passed.

In the depicted implementation, the guide catheter 120 is installed(e.g., via the groin incision 2, refer to FIG. 27) by pushing it overthe guidewire 110. In some implementations, a dilator tip is used inconjunction with the guide catheter 120 as the guide catheter 120 isadvanced over the guidewire 110. Alternatively, a balloon catheter couldbe used as the initial dilation means. After the distal end of the guidecatheter 120 reaches the left atrium 16, the dilator tip can bewithdrawn.

By making various adjustments at the proximal end of the guide catheter120 (as described further below), a clinician can attain a desirableorientation of the guide catheter 120 in relation to the heart 10. Forexample, the guide catheter 120 can be rotated about its longitudinalaxis so that the longitudinal axis of the distal-most tip portion of theguide catheter 120 is pointing toward the perpendicular axis of themitral valve 17. Such rotational movement of the guide catheter 120 canbe performed by the clinician as described further below. In addition,in some embodiments a distal end portion of the guide catheter 120 issteerable (also referred to herein as “deflectable”). Using suchsteering, the distal end portion of the guide catheter 120 can bedeflected to navigate the patient's anatomy and/or to be positioned inrelation to the patient's anatomy as desired. For example, the guidecatheter 120 can be angled within the right atrium 12 to navigate theguide catheter 120 from the inferior vena cava 11 to the atrial septum15. Accordingly, in some embodiments the guide catheter 120 may includeat least one deflection zone 122. As described further below, aclinician can controllably deflect the deflection zone of the guidecatheter 120 as desired.

After the guide catheter 120 is oriented within the heart 10 as desiredby the clinician, in some embodiments the clinician can releasably lockthe guide catheter 120 in the desired orientation. For example, asdescribed further below, in some embodiments the clinician canreleasably lock the guide catheter 120 to a frame assembly that isstationary in relation to the patient.

Still referring to FIG. 1, in some embodiments the guide catheter 120has an outer diameter of about 28 Fr (about 9.3 mm), or about 30 Fr(about 10.0 mm). In some embodiments, the guide catheter 120 has anouter diameter in the range of about 26 Fr to about 34 Fr (about 8.7 mmto about 11.3 mm). In some embodiments, the guide catheter 120 has anouter diameter in the range of about 20 Fr to about 28 Fr (about 6.7 mmto about 9.3 mm).

The guide catheter 120 can comprise a tubular polymeric or metallicmaterial. For example, in some embodiments the guide catheter 120 can bemade from polymeric materials such as, but not limited to,polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP),HYTREL®, nylon, PICOFLEX®, PEBAX®, TECOFLEX®, and the like, andcombinations thereof. In alternative embodiments, the guide catheter 120can be made from metallic materials such as, but not limited to,nitinol, stainless steel, stainless steel alloys, titanium, titaniumalloys, and the like, and combinations thereof. In some embodiments, theguide catheter 120 can be made from combinations of such polymeric andmetallic materials (e.g., polymer layers with metal braid, coilreinforcement, stiffening members, and the like, and combinationsthereof). In some embodiments, the guide catheter 120 can comprise aslotted tube.

The example delivery system 100 also includes the anchor delivery sheath130. In some implementations, after the guide catheter 120 is positionedwith its distal end in the left atrium 16, the anchor delivery sheath130 is installed into a lumen of the guide catheter 120 (over theguidewire 110) and advanced through the guide catheter 120. As describedfurther below, in some embodiments the anchor delivery sheath 130 ispreloaded with a prosthetic valve anchor assembly and other componentsof the delivery system 100.

In some embodiments, the anchor delivery sheath 130 can be made from thematerials described above in reference to the guide catheter 120. Insome embodiments, the anchor delivery sheath 130 has an outer diameterin the range of about 20 Fr to about 28 Fr (about 6.7 mm to about 9.3mm). In some embodiments, the anchor delivery sheath 130 has an outerdiameter in the range of about 14 Fr to about 24 Fr (about 4.7 mm toabout 8.0 mm).

In the depicted embodiment, the anchor delivery sheath 130 includes aflared distal end portion 132. In some embodiments, no such flareddistal end portion 132 is included. The flared distal end portion 132can collapse to a lower profile when constrained within the guidecatheter 120. When the flared distal end portion 132 is expressed fromthe guide catheter 120, the flared distal end portion 132 canself-expand to the flared shape. In some embodiments, the material ofthe flared distal end portion 132 includes pleats or folds, may be acontinuous flared end or may be separated into sections resemblingflower petals, and may include one or more resilient elements that biasthe flared distal end portion 132 to assume the flared configuration inthe absence of restraining forces (such as from containment within theguide catheter 120). The flared distal end portion 132 can beadvantageous, for example, for recapturing (if desired) the anchorassembly within the lumen of the anchor delivery sheath 130 after theanchor assembly has been expressed from the flared distal end portion132.

In some embodiments, the maximum outer diameter of the flared distal endportion 132 is in a range of about 30 Fr to about 34 Fr (about 10.0 mmto about 11.3 mm). In some embodiments, the maximum outer diameter ofthe flared distal end portion 132 is in a range of about 32 Fr to about44 Fr (about 10.7 mm to about 14.7 mm). In some embodiments, the maximumouter diameter of the flared distal end portion 132 is in a range ofabout 24 Fr to about 30 Fr (about 8.0 mm to about 10.0 mm). In someembodiments, the maximum outer diameter of the flared distal end portion132 is less than about 24 Fr (about 8.0 mm) or greater than about 44 Fr(about 14.7 mm).

Referring to FIG. 2, additional components of the example deliverysystem 100 can include an anchor delivery catheter 140, a secondarysteerable catheter 150, and an inner catheter 160. The anchor deliverycatheter 140 is slidably disposed within a lumen of the anchor deliverysheath 130. The secondary steerable catheter 150 is slidably disposedwithin a lumen of the anchor delivery catheter 140. The inner catheter160 is slidably disposed within a lumen of the secondary steerablecatheter 150. The guidewire 110 is slidably disposed within a lumen ofthe inner catheter 160.

An anchor assembly 200 is releasably attached to the inner catheter 160and is, in effect, slidably disposed on the guidewire 110. As describedfurther below, the components of the delivery system 100 can beindividually or jointly manipulated by a clinician operator to controlthe position and orientation of the anchor assembly 200 during thedeployment of the anchor assembly 200. In some implementations, adeployment frame system (such as the example deployment frame systemsdescribed below) is used to initiate and/or control the movements ofvarious components of the transcatheter delivery system 100.

In a preferred implementation of delivery system 100, the anchordelivery catheter 140, the secondary steerable catheter 150, the innercatheter 160, and the anchor assembly 200 are loaded into the anchordelivery sheath 130 prior to the advancement of the anchor deliverysheath 130 into the guide catheter 120 as shown in FIG. 1. That is, in apreferred implementation the anchor delivery catheter 140, the secondarysteerable catheter 150, the inner catheter 160, and/or the anchorassembly 200 are already installed in the anchor delivery sheath 130 asthe anchor delivery sheath 130 is distally advanced into the guidecatheter 120 to attain the arrangement shown in FIG. 1. Then the anchordelivery sheath 130 is individually pulled back (proximally) to revealthe anchor delivery catheter 140, the secondary steerable catheter 150,the inner catheter 160, and/or the anchor assembly 200 as shown in FIG.2. The anchor assembly 200 may also be at least partially expanded. Insome such implementations, the anchor delivery catheter 140, thesecondary steerable catheter 150, the inner catheter 160, and/or theanchor assembly 200 are loaded into the anchor delivery sheath 130 indesired relative rotational orientations (i.e., rotational orientationsabout the longitudinal axis of the delivery system 100). In otherimplementations, one or more of the anchor delivery catheter 140, thesecondary steerable catheter 150, the inner catheter 160, and the anchorassembly 200 are distally advanced into the anchor delivery sheath 130after the anchor delivery sheath 130 has been advanced into the guidecatheter 120 to attain the arrangement shown in FIG. 1.

The inner catheter 160 is releasably coupled with a hub 210 of theanchor assembly 200. One or more portions of the anchor assembly 200 arealso releasably coupled to the anchor delivery catheter 140 by one ormore control wires 142. In some embodiments, the one or more controlwires 142 are slidably disposed within lumens of the anchor deliverycatheter 140 and threaded through one or more portions of the anchorassembly 200 (e.g., through eyelets of the anchor assembly 200). Whilethe depicted embodiment includes one control wire 142, in someembodiments two, three, four, five, or more than five control wires areincluded. For example, in a preferred embodiment two control wires 142are included. One of the two control wires 142 is releasably coupledwith a proximal end of the anchor assembly 200, and a second of the twocontrol wires 142 is releasably coupled with a mid-body portion of theanchor assembly 200. A clinician can separately control the two controlwires 142. In some implementations, a deployment frame system (such asthe example deployment frame systems described below) is used to controlthe movements of the two control wires 142.

While the components of the delivery system 100 and the anchor assembly200 are depicted in particular relative orientations and arrangements,it should be understood that the depictions are non-limiting. Forexample, in some implementations of the deployment process the distaltip of the secondary deflectable catheter 150 may always be, or maysometimes be, abutted to the hub 210 of the anchor assembly 200.Further, in some implementations of the deployment process the distaltip of the anchor delivery catheter 140 may always be, or may sometimesbe, positioned within the interior of the anchor assembly 200. In someimplementations, a deployment frame system (such as the exampledeployment frame systems described below) is used to control suchrelative arrangements and movements of the anchor delivery catheter 140and secondary deflectable catheter 150 in relation to the anchorassembly 200, for example.

In some embodiments, the position of the anchor assembly 200 can becontrolled by manipulating the relative positions of the inner catheter160 and/or the anchor delivery catheter 140. For example, in thedepicted embodiment the anchor assembly 200 can be expressed out fromthe anchor delivery sheath 130 (as shown in FIG. 2) by moving the innercatheter 160 and/or the anchor delivery catheter 140 distally inrelation to the anchor delivery sheath 130. In some implementations, theexpression of the anchor assembly 200 is caused by proximally pullingback the anchor delivery sheath 130 while generally maintaining thepositions of the inner catheter 160 and/or the anchor delivery catheter140. In some implementations, the expression of the anchor assembly 200is caused by a combination of proximally pulling back the anchordelivery sheath 130 while distally extending the positions of the innercatheter 160 and/or the anchor delivery catheter 140.

As the anchor assembly 200 emerges from the confines of the anchordelivery sheath 130, the anchor assembly 200 may expand from alow-profile delivery configuration to an at least partially expandedconfiguration (as shown in FIG. 2). The extent of expansion of theanchor assembly 200 can be at least partially controlled by the relativepositioning of the anchor delivery catheter 140 in relation to the innercatheter 160. For instance, as the anchor delivery catheter 140 is movedproximally in relation to the inner catheter 160, the anchor assembly200 is axially elongated and radially contracted. Conversely, as theanchor delivery catheter 140 is moved distally in relation to the innercatheter 160, the anchor assembly 200 is axially shortened and radiallyexpanded. In some implementations, this control of the radial size ofthe anchor assembly 200 is used by a clinician during the process ofdeploying the anchor assembly 200 within the native mitral valve 17, asdescribed further below. As described further below, the one or morecontrol wires 142 can also be used to control some radial expansion ofthe anchor assembly 200 (without changing the relative distance of theanchor delivery catheter 140 in relation to the inner catheter 160).

It should be understood that the prosthetic mitral valves providedherein are comprised of an anchor assembly 200 and a separate valveassembly (e.g., refer to FIG. 22). The anchor assembly 200 is deployedto an arrangement interfacing within the native mitral valve 17 prior todeployment of the valve assembly. Said differently, after implanting theanchor assembly 200 within the native mitral valve 17, the valveassembly can then be deployed within the anchor assembly 200 and withinthe native mitral valve 17 (as described further below). Therefore, itcan be said that the prosthetic mitral valves provided herein aredeployed using a staged implantation method. That is, the anchorassembly 200 is deployed in one stage, and the valve assembly isdeployed in a subsequent stage. In some embodiments, as describedfurther below, a SAM containment member is deployed as part of thedeployment method. In some implementations, the deployment of the valveassembly takes place right after the deployment of the anchor assembly200 (e.g., during the same medical procedure). In some implementations,the deployment of the valve assembly takes place hours, days, weeks, oreven months after the deployment of the anchor assembly 200 (e.g.,during a subsequent medical procedure).

The staged implantation method of the prosthetic mitral valves providedherein is facilitated by the fact that when the anchor assembly 200itself is implanted within the native mitral valve 17, the native mitralvalve 17 continues to function essentially as before the implantation ofthe anchor assembly 200 without a significant impact on cardiovascularphysiology. That is the case because, as described further below, theanchor assembly 200 interfaces and anchors within structural aspects ofthe native mitral valve 17 without substantially interfering with theleaflets or chordae tendineae of the native mitral valve 17.

Still referring to FIG. 2, in the depicted arrangement the distal endportion of the secondary steerable catheter 150 is located at leastpartially internally within the anchor assembly 200. The secondarysteerable catheter 150 can be manipulated by a clinician operator toreversibly bend (deflect) the distal end portion of the secondarysteerable catheter 150. As the secondary steerable catheter 150 is bentby the clinician, other components of the delivery system 100 maydeflect along with the secondary steerable catheter 150. For example,portions of one or more of the inner catheter 160 and the anchordelivery catheter 140 may bend in response to the bending of thedeflectable catheter 150. Because the anchor assembly 200 is coupled tothe inner catheter 160 and the anchor delivery catheter 140, the anchorassembly 200 can, in turn, be pivoted or “panned” by bending thesecondary steerable catheter 150.

Referring to FIG. 3, as described above, in some embodiments thesecondary steerable catheter 150 can be articulated (also referred to as“steered,” “deflected,” “bent,” “curved,” and the like) to orient theanchor assembly 200 in relation to the mitral valve 17 as desired. Thatis, in some embodiments the secondary steerable catheter 150 has one ormore deflection zones at a distal end portion of the secondary steerablecatheter 150. For example, in the depicted embodiment the secondarysteerable catheter 150 has two deflection zones 152 and 154 (refer toFIG. 5) at the distal end portion of the secondary steerable catheter150. In some embodiments, the two deflection zones 152 and 154 allow fordeflection of the distal end portion of the secondary steerable catheter150 within two separate and distinct planes. For example, in thedepicted embodiment deflection zone 152 allows for deflection of thedistal end portion of the secondary steerable catheter 150 generallywithin the plane of FIGS. 1-4, while deflection zone 154 allows fordeflection of the distal end portion of the secondary steerable catheter150 generally orthogonal to the plane of FIGS. 1-4. In someimplementations, a deployment frame system (such as the exampledeployment frame systems described below) is used to initiate andcontrol such deflection of the secondary steerable catheter 150,including deflection of the distal end portion of the secondarysteerable catheter 150 within two separate and distinct planes,individually.

In some implementations, it is desirable to orient (e.g., laterallypivot, pan, etc.) the anchor assembly 200 within the atrium 16 so thatthe longitudinal axis of the anchor assembly 200 is generallyperpendicular to the native mitral valve 17, and coaxial with the nativemitral valve 17 (e.g., to center the anchor assembly 200 with the lineor coaptation of the mitral valve 17). The orienting of the partially orfully expanded anchor assembly 200 within the atrium 16 may beadvantageous versus having to orient the anchor assembly 200 while it isstill constrained within a delivery sheath, as the latter assembly is arelatively large and stiff catheter assembly.

In some implementations, the anchor assembly 200 within the atrium 16can be additionally, or alternatively, oriented in relation to thenative mitral valve 17 by rotating the guide catheter 120 about itslongitudinal axis. Such a rotation of the guide catheter 120 about itslongitudinal axis can result in a directional adjustment of thelongitudinal axis of the distal tip portion of the guide catheter 120.That is, rotation of the guide catheter 120 about its longitudinal axiscan result in pointing the distal tip portion of the guide catheter 120(and the components of the delivery system 100) in a desired directionwithin the atrium 16. In some implementations, a deployment frame system(such as the example deployment frame systems described below) is usedto initiate and control such rotation of the guide catheter 120 aboutits longitudinal axis.

In some implementations, the relative rotational alignment of the anchorassembly 200 in relation to the mitral valve 17 can be adjusted asdesired in preparation for engaging the anchor assembly 200 with thenative mitral valve 17. For example, in some implementations the anchorassembly 200 can be rotated about its longitudinal axis by rotating theinner catheter 160 and the anchor delivery catheter 140 generally inunison, while keeping the secondary steerable catheter 150 essentiallystationary. In some implementations, a deployment frame system (such asthe example deployment frame systems described below) is used toinitiate and control such rotation of the anchor assembly 200 about itslongitudinal axis.

In preparation for engaging the anchor assembly 200 with the nativemitral valve 17, the clinician operator may manipulate the radial sizeof the anchor frame 200 so that the anchor frame 200 can be passedthrough the native mitral valve 17 without damaging the native mitralvalve 17. For example, the clinician can move the anchor deliverycatheter 140 proximally in relation to the inner catheter 160 toradially contract the anchor assembly 200. Alternatively, oradditionally, the clinician can diametrically expand or retract one ormore portions of the anchor assembly 200 by manipulation of the one ormore control wires 142. With the anchor assembly 200 radially contractedin a desired orientation, and appropriately aligned with the mitralvalve 17, the anchor frame 200 can be safely passed through the nativemitral valve 17 without damaging the native mitral valve 17 and/orentangling chordae tendineae of the mitral valve 17.

Referring to FIG. 4, while the secondary steerable catheter 150 isretained in its bent (deflected) configuration as described in referenceto FIG. 3, the inner catheter 160 and the anchor delivery catheter 140can be simultaneously advanced. Because the inner catheter 160 isreleasably coupled to the hub 210 of the anchor assembly 200, andbecause the anchor delivery catheter 140 is releasably coupled to atleast the proximal end of the anchor assembly 200 via the one or morecontrol wires 142, generally simultaneous advancement of the innercatheter 160 and the anchor delivery catheter 140 results in advancementof the anchor assembly 200. The anchor assembly 200 is advanced suchthat the distal end of anchor assembly 200 is within the left ventricle18 while the proximal end of the anchor assembly 200 is within the leftatrium 16. Hence, some portions of the anchor assembly 200 are on eachside of the native mitral valve 17. As described further below,simultaneous movement of two or more components of the delivery system100 (e.g., the inner catheter 160 in conjunction with the anchordelivery catheter 140) can be initiated and controlled using adeployment frame system (such as the example deployment frame systemsdescribed below) in some implementations.

In the depicted embodiment, the anchor assembly 200 includes four anchorfeet: a lateral anterior foot 220 a, a lateral posterior foot 220 b, amedial posterior foot 220 c, and a medial anterior foot 220 d. In someembodiments, fewer or more anchor feet may be included (e.g., two,three, five, six, or more than six). In some embodiments, the anchorfeet 220 a, 220 b, 220 c, and 220 d are portions of the anchor assembly200 that are configured for contact with a sub-annular gutter 19 of thenative mitral valve 17, without penetrating tissue of the native mitralvalve 17. Accordingly, the anchor feet 220 a, 220 b, 220 c, and 220 dhave atraumatic surfaces that are generally comparable to feet. However,in some embodiments one or more of the anchor feet 220 a, 220 b, 220 c,and 220 d are configured to penetrate tissue and may have anchorfeatures such as barbs, coils, hooks, and the like.

In the arrangement of FIG. 4, the anchor feet 220 a, 220 b, 220 c, and220 d are positioned below the sub-annular gutter 19. In thisarrangement, the radial size of the anchor assembly 200 can be increasedto align the anchor feet 220 a, 220 b, 220 c, and 220 d with thesub-annular gutter 19. For example, in some embodiments the cliniciancan move the anchor delivery catheter 140 distally in relation to theinner catheter 160 to radially expand the anchor assembly 200 to alignthe anchor feet 220 a, 220 b, 220 c, and 220 d with the sub-annulargutter 19. Alternatively, or additionally, in some embodiments amid-body control wire 142 positioned on or around a mid-body portion ofthe anchor assembly 200 can be manipulated (e.g., slackened) to allowradial self-expansion of the anchor assembly 200, to align the anchorfeet 220 a, 220 b, 220 c, and 220 d with the sub-annular gutter 19. Suchalignment can be performed in preparation for seating the anchor feet220 a, 220 b, 220 c, and 220 d within the sub-annular gutter 19.

Referring to FIG. 5, a commissural cross-sectional view of the heart 10provides another perspective of the anchor assembly 200 in the samearrangement in relation to the native mitral valve 17 as shown in FIG.4. This commissural cross-sectional view of the heart 10 is across-sectional view taken through the mitral valve 17 along a planethrough the left atrium 16 and left ventricle 18 that is parallel to theline that intersects the two commissures of the mitral valve 17 (asdescribed further in reference to FIG. 8 below). In the following FIGS.5-7 and 15-19, the commissural cross-sectional view of the heart 10 willbe used to describe the delivery system 100 and methods for deployingthe prosthetic mitral valves provided herein. The view in FIGS. 5-7 and15-19 is slightly tilted so that better visualization of the anchorassembly 200 is provided.

The anchor feet 220 a, 220 b, 220 c, and 220 d are positioned below thesub-annular gutter 19. In this position, the anchor feet 220 a, 220 b,220 c, and 220 d are positioned under the systolic and diastolicexcursions of the leaflets of the native mitral valve 17. In thisorientation, the anchor feet 220 a, 220 b, 220 c, and 220 d can bealigned with the sub-annular gutter 19 in preparation for seating theanchor feet 220 a, 220 b, 220 c, and 220 d within the sub-annular gutter19.

In this figure, portions of an example SAM containment member 212 are inview. In the depicted embodiment, the SAM containment member 212 extendsfrom the anchor assembly 200. For example, the SAM containment member212 comprises an elongate member with a first end that extends from afirst portion of the anchor assembly 200 and a second end that extendsfrom a second portion of the anchor assembly 200. In particularembodiments, the SAM containment member 212 is integrally formed as partof the anchor assembly 200. In specific embodiments, the SAM containmentmember 212, or portions thereof, may be formed separately from theanchor assembly 200 and thereafter attached to the anchor assembly 200.

The SAM containment member 212 can be arranged in a pre-deployedconfiguration as shown. As described further below, the SAM containmentmember 212 can be reconfigured to a deployed configuration such that theSAM containment member 212 physically prevents an anterior leaflet of anative mitral valve from obstructing the LVOT. In some embodiments, theSAM containment member 212 is biased to self-reconfigure to the deployedconfiguration when the SAM containment member 212 is unconstrained.While one particular embodiment of the SAM containment member 212 isdepicted, it should be understood that multiple SAM containment memberembodiments are envisioned and within the scope of this disclosure.

Referring to FIG. 6, the inner catheter 160 and the anchor deliverycatheter 140 can be simultaneously retracted while maintaining thesecondary steerable catheter 150 and the guide catheter 120 in fixedpositions. As a result, the anchor feet 220 a, 220 b, 220 c, and 220 dbecome seated in the sub-annular gutter 19. As described further below,simultaneous movement of two or more components of the delivery system100 (e.g., the inner catheter 160 in conjunction with the anchordelivery catheter 140, while maintaining the secondary steerablecatheter 150 and the guide catheter 120 in fixed positions) can beinitiated and controlled using a deployment frame system (such as theexample deployment frame systems described below) in someimplementations.

With the anchor feet 220 a, 220 b, 220 c, and 220 d seated in thesub-annular gutter 19, the anchor feet 220 a, 220 b, 220 c, and 220 dare positioned under the systolic and diastolic excursions of theleaflets of the native mitral valve 17, and the other structures of theanchor assembly 200 do not inhibit the movements of the leaflets.Therefore, with the anchor assembly 200 coupled to the structures of themitral valve 17 as described, the mitral valve 17 can continue tofunction as it did before the placement of the anchor assembly 200. Inaddition, the manner in which the anchor assembly 200 interfaces withthe native mitral valve 17 does not result in deformation of the nativemitral valve 17. With the SAM containment member 212 in its pre-deployedconfiguration, the SAM containment member 212 does not affect thenatural function of the native mitral valve 17. Therefore, the nativemitral valve 17 can continue to function as it did before the placementof the anchor assembly 200.

Referring to FIG. 7, with the anchor assembly 200 engaged within thenative mitral valve 17, components of the delivery system 100 can bewithdrawn from the anchor assembly 200. For example, the one or morecontrol wires 142 can be detached from the anchor assembly 200 (e.g.,from the mid-body and proximal end portions of the anchor assembly 200in some embodiments). When the control wire 142 is detached from aproximal end portion of the anchor assembly, in some embodiments atrialholding features 240 a, 240 b, 240 c, and 240 d (refer to FIGS. 9-11)self-deploy to respective positions directly adjacent to, or spacedapart just above, the annulus of the mitral valve 17.

With the anchor assembly 200 deployed within the mitral valve 17 (asdescribed above), the anchor delivery catheter 140 can be withdrawn, thesecondary steerable catheter 150 can be withdrawn, and the anchordelivery sheath 130 can also be withdrawn. In fact, if so desired, theanchor delivery catheter 140, the secondary steerable catheter 150, andthe anchor delivery sheath 130 can be completely withdrawn from theguide catheter 120. In contrast, in some implementations the innercatheter 160 is advantageously left attached to the hub 210 of theanchor assembly 200 (and left attached to the SAM containment member 212in some implementations). As will be described further below, in someimplementations the inner catheter 160 can be used as a rail on which avalve assembly is later deployed into the interior of the anchorassembly 200. However, in some implementations the anchor assembly 200is completely detached from the delivery system 100, and the deliverysystem 100 is removed from the patient. After a period of minutes,hours, days, weeks, or months, subsequent to the deployment of theanchor assembly 200, a valve assembly can be installed into the anchorassembly 200 to complete the installation of the prosthetic mitralvalve.

In some implementations, withdrawal of the anchor delivery catheter 140,the secondary steerable catheter 150, and the anchor delivery sheath 130can be performed as follows. First, the anchor delivery catheter 140 canbe withdrawn into the anchor delivery sheath 130. Then, the secondarysteerable catheter 150 can be withdrawn into the anchor delivery sheath130 while generally simultaneously undeflecting (relaxing) the bend(s)in the secondary steerable catheter 150. Thereafter, in some embodimentsthe anchor delivery catheter 140, the secondary steerable catheter 150,and the anchor delivery sheath 130 can be simultaneously withdrawnfurther, including up to completely from the guide catheter 120. Asdescribed further below, such individual and/or simultaneous movementsof components of the delivery system 100 can be initiated and controlledusing a deployment frame system (such as the example deployment framesystems described below) in some implementations.

In the depicted implementation, the SAM containment member 212 is stillrestrained in its pre-deployed configuration. As described furtherbelow, in some embodiments the depicted embodiment of the SAMcontainment member 212 is deployed after the installation of a valveassembly into the anchor assembly 200. Alternatively, as describedfurther below, in some embodiments of the SAM containment member 212,the SAM containment member 212 is deployed prior to the installation ofa valve assembly into the anchor assembly 200.

Referring to FIG. 8, the anatomy of the native mitral valve 17 includessome consistent and predictable structural features across patients thatcan be utilized for engaging the anchor assembly 200 therewith. Forexample, the native mitral valve 17 includes the aforementionedsub-annular gutter 19. In addition, the native mitral valve 17 includesa D-shaped annulus 28, an anterolateral commissure 30 a, a posteromedialcommissure 30 b, a left fibrous trigone 134 a, and a right fibroustrigone 134 b. Further, the native mitral valve 17 includes an anteriorleaflet 20 and a three-part posterior leaflet 22. The posterior leaflet22 includes a lateral scallop 24 a, a middle scallop 24 b, and a medialscallop 24 c. The free edges of the posterior leaflet 22 and theanterior leaflet 20 meet along a coaptation line 32.

The D-shaped annulus 28 defines the structure from which the anteriorleaflet 20 and posterior leaflet 22 extend and articulate. The left andright fibrous trigones 134 a and 134 b are located near the left andright ends of the anterior leaflet 20 and generally adjacent the lateraland medial scallops 24 a and 24 c of the posterior leaflet 22. Thesub-annular gutter 19 runs along the annulus 28 between the left andright fibrous trigones 134 a and 134 b along the posterior leaflet 22.

The regions at or near the high collagen annular trigones 134 a and 134b can generally be relied upon to provide strong, stable anchoringlocations. The muscle tissue in the regions at or near the trigones 134a and 134 b also provides a good tissue ingrowth substrate for addedstability and migration resistance of the anchor assembly 200.Therefore, the regions at or near the trigones 134 a and 134 b define aleft anterior anchor zone 34 a and a right anterior anchor zone 34 brespectively. The left anterior anchor zone 34 a and the right anterioranchor zone 34 b provide advantageous target locations for placement ofthe lateral anterior foot 220 a and the medial anterior foot 220 drespectively.

Referring also to FIG. 9, the depicted embodiment of the anchor assembly200 also includes the lateral posterior foot 220 b and the medialposterior foot 220 c. As previously described, the lateral posteriorfoot 220 b and the medial posterior foot 220 c can also beadvantageously positioned in the sub-annular gutter 19 in order toprovide balanced and atraumatic coupling of the anchor assembly 200 tothe native mitral valve 17. Therefore, a left posterior anchor zone 34 band a right anterior anchor zone 34 c are defined in the sub-annulargutter 19. The left posterior anchor zone 34 b and the right anterioranchor zone 34 c can receive the lateral posterior foot 220 b and themedial posterior foot 220 c respectively. In some implementations, thelocations of the left posterior anchor zone 34 b and the right anterioranchor zone 34 c may vary from the depicted locations while stillremaining within the sub-annular gutter 19. It should be understood thatthe depicted anchor assembly 200 is merely one non-limiting example ofthe anchor assemblies provided within the scope of this disclosure.

In some embodiments, the anchor assembly 200 includes supra-annularstructures and sub-annular structures. For example, the sub-annularstructures of the anchor assembly 200 include the aforementioned anchorfeet 220 a, 220 b, 220 c, and 220 d, the SAM containment member 212, andthe hub 210. In some embodiments, as described above, the hub 210functions as a connection structure for the delivery system 100 (e.g.,refer to FIG. 2). In addition, the hub 210 can function as a stabilizingstructural component from which a lateral anterior sub-annular supportarm 230 a, a lateral posterior sub-annular support arm 230 b, a medialposterior sub-annular support arm 230 c, and a medial anteriorsub-annular support arm 230 d extend to the anchor feet 220 a, 220 b,220 c, and 220 d respectively.

In the depicted embodiment, the SAM containment member 212 includes alateral anterior arm 213 a and a medial anterior arm 213 d. The lateralanterior arm 213 a extends from the lateral anterior sub-annular supportarm 230 a. The medial anterior arm 213 d extends from the medialanterior sub-annular support arm 230 d. In some embodiments, portions ofthe SAM containment member 212 may extend from other areas on the anchorassembly 200.

In some embodiments, such as the depicted embodiment, the supra-annularstructures of the anchor assembly 200 include: a lateral anterior atrialholding feature 240 a, a lateral posterior atrial holding feature 240 b,a medial posterior atrial holding feature 240 c, and a medial anterioratrial holding feature 240 d; an anterior anchor arch 250 a, a leftanchor arch 250 b, a posterior anchor arch 250 c, and a right anchorarch 250 d; and connection bridges 260. The anterior anchor arch 250 a,left anchor arch 250 b, posterior anchor arch 250 c, and right anchorarch 250 d are joined with each other to form an undulatingsupra-annular ring 250 that acts as a supra-annular structural elementfor the anchor assembly 200. As will be described further below, thesupra-annular ring 250 also defines an opening to a space within theinterior of the anchor assembly 200 that is configured to receive andengage with a valve assembly. The atrial holding features 240 a, 240 b,240 c, and 240 d are configured to contact the shelf-like supra-annulartissue surface above the mitral valve annulus, and to thereby stabilizethe anchor assembly 200 in supra-annular areas that are generallyopposite of the anchor feet 220 a, 220 b, 220 c, and 220 d respectively.

In some embodiments, connection bridges 260 provide enhanced stabilityand fatigue resistance from vertically oriented forces on a companionartificial valve assembly when the valve (not shown) is closed andblocking pressurized blood during systole. The anchor assembly 200 canalso include one or more eyelets 226 in frame portions adjacent thearches, which are additional control points for delivery and retrievalof the assembly, or could be used to secure a positional delivery frame.

In some embodiments, such as the depicted embodiment, the supra-annularstructures and sub-annular structures of the anchor assembly 200 areinterconnected by a lateral anterior inter-annular connection 270 a, alateral posterior inter-annular connection 270 b, a medial posteriorinter-annular connection 270 c, and a medial anterior inter-annularconnection 270 d. For example, the lateral anterior inter-annularconnection 270 a connects the lateral anterior anchor foot 220 a withthe lateral anterior atrial holding feature 240 a. In addition, thelateral anterior inter-annular connection 270 a connects the lateralanterior anchor foot 220 a with the anterior anchor arch 250 a and theleft anchor arch 250 b. In the depicted embodiment, each of the otherinter-annular connections 270 b, 270 c, and 270 d interconnect portionsof the supra-annular structures and sub-annular structures in mannersanalogous to that of the lateral anterior inter-annular connection 270a. For example, the lateral anterior inter-annular connection 270 bconnects the lateral anterior anchor foot 220 b with the left anchorarch 250 b and the posterior anchor arch 250 c; the lateral anteriorinter-annular connection 270 c connects the lateral anterior anchor foot220 c with the posterior anchor arch 250 c and the right anchor arch 250d; and the lateral anterior inter-annular connection 270 d connects thelateral anterior anchor foot 220 d with the right anchor arch 250 d andthe anterior anchor arch 250 a.

In some embodiments, the elongate members of the anchor assembly 200,including SAM containment member 212, are formed from a single piece ofprecursor material (e.g., sheet or tube) that is cut, expanded, andconnected to the hub 210. For example, some embodiments are fabricatedfrom a tube that is laser-cut (or machined, chemically etched, water-jetcut, etc.) and then expanded and heat-set into its final expanded sizeand shape. In some embodiments, the anchor assembly 200, including SAMcontainment member 212, is created compositely from multiple elongatemembers (e.g., wires or cut members) that are joined together with thehub 210 and each other to form the anchor assembly 200.

The elongate members of the anchor assembly 200 can be comprised ofvarious materials and combinations of materials. In some embodiments,nitinol (NiTi) is used as the material of the elongate members of theanchor assembly 200, but other materials such as stainless steel, L605steel, polymers, MP35N steel, stainless steels, titanium,cobalt/chromium alloy, polymeric materials, Pyhnox, Elgiloy, or anyother appropriate biocompatible material, and combinations thereof canbe used. The super-elastic properties of NiTi make it a particularlygood candidate material for the elongate members of the anchor assembly200 because, for example, NiTi can be heat-set into a desired shape.That is, NiTi can be heat-set so that the anchor assembly 200 tends toself-expand into a desired shape when the anchor assembly 200 isunconstrained, such as when the anchor assembly 200 is deployed out fromthe anchor delivery sheath 130. A anchor assembly 200 made of NiTi, forexample, may have a spring nature that allows the anchor assembly 200 tobe elastically collapsed or “crushed” to a low-profile deliveryconfiguration and then to reconfigure to the expanded configuration asshown in FIG. 9. The anchor assembly 200 may be generally conformable,fatigue resistant, and elastic such that the anchor assembly 200 canconform to the topography of the surrounding tissue when the anchorassembly 200 is deployed in a native mitral valve of a patient.

In some embodiments, the diameter or width/thickness of one or more ofthe elongate members forming the anchor assembly 200 may be within arange of about 0.008″ to about 0.015″ (about 0.20 mm to about 0.40 mm),or about 0.009″ to about 0.030″ (about 0.23 mm to about 0.76 mm), orabout 0.01″ to about 0.06″ (about 0.25 mm to about 1.52 mm), or about0.02″ to about 0.10″ (about 0.51 mm to about 2.54 mm), or about 0.06″ toabout 0.20″ (about 1.52 mm to about 5.08 mm). In some embodiments, theelongate members forming the anchor assembly 200 may have smaller orlarger diameters or widths/thicknesses. In some embodiments, each of theelongate members forming the anchor assembly 200 has essentially thesame diameter or width/thickness. In some embodiments, one or more ofthe elongate members forming the anchor assembly 200 has a differentdiameter or width/thickness than one or more of the other elongatemembers of the anchor assembly 200. In some embodiments, one or moreportions of one or more of the elongate members forming the anchorassembly 200 may be tapered, widened, narrowed, curved, radiused, wavy,spiraled, angled, and/or otherwise non-linear and/or not consistentalong the entire length of the elongate members of the anchor assembly200. Such features and techniques can also be incorporated with thevalve assemblies of the prosthetic mitral valves provided herein.

In some embodiments, the elongate members forming the anchor assembly200 may vary in diameter, thickness and/or width so as to facilitatevariations in the forces that are exerted by the anchor assembly 200 inspecific regions thereof, to increase or decrease the flexibility of theanchor assembly 200 in certain regions, to enhance migration resistance,and/or to control the process of compression (crushability) inpreparation for deployment and the process of expansion duringdeployment of the anchor assembly 200.

In some embodiments, one or more of the elongate members of the elongatemembers forming the anchor assembly 200 may have a circularcross-section. In some embodiments, one or more of the elongate membersforming the anchor assembly 200 may have a rectangular cross-sectionalshape, or another cross-sectional shape that is not rectangular.Examples of cross-sectional shapes that the elongate members forming theanchor assembly 200 may have include circular, C-shaped, square, ovular,rectangular, elliptical, triangular, D-shaped, trapezoidal, includingirregular cross-sectional shapes formed by a braided or strandedconstruct, and the like. In some embodiments, one or more of theelongate members forming the anchor assembly 200 may be essentially flat(i.e., such that the width to thickness ratio is about 2:1, about 3:1,about 4:1, about 5:1, or greater than about 5:1). In some examples, oneor more of the elongate members forming the anchor assembly 200 may beformed using a center-less grind technique, such that the diameter ofthe elongate members varies along the length of the elongate members.

The anchor assembly 200 may include features that are directed toenhancing one or more desirable functional performance characteristicsof the prosthetic mitral valve devices. For example, some features ofthe anchor assembly 200 may be directed to enhancing the conformabilityof the prosthetic mitral valve devices. Such features may facilitateimproved performance of the prosthetic mitral valve devices by allowingthe devices to conform to irregular tissue topographies and/ordynamically variable tissue topographies, for example. Suchconformability characteristics can be advantageous for providingeffective and durable performance of the prosthetic mitral valvedevices. In some embodiments of the anchor assembly 200, some portionsof the anchor assembly 200 are designed to be more conformable thanother portions of the same anchor assembly 200. That is, theconformability of a single anchor assembly 200 can be designed to bedifferent at various areas of the anchor assembly 200.

In some embodiments, the anchor assembly 200 includes features forenhanced in vivo radiographic visibility. In some embodiments, portionsof the anchor assembly 200, such as one or more of the anchor feet 220a, 220 b, 220 c, and 220 d, and/or SAM containment member 212, may haveone or more radiopaque markers attached thereto. In some embodiments,some or all portions of the anchor assembly 200 are coated (e.g.,sputter coated) with a radiopaque coating.

Still referring to FIGS. 8 and 9, as described above the anchor feet 220a, 220 b, 220 c, and 220 d are sized and shaped to engage thesub-annular gutter 19 of the mitral valve 17. In some embodiments, theanterior feet 220 a and 220 d are spaced apart from each other by adistance in a range of about 30 mm to about 45 mm, or about 20 mm toabout 35 mm, or about 40 mm to about 55 mm. In some embodiments, theposterior feet 220 b and 220 c are spaced apart from each other by adistance in a range of about 20 mm to about 30 mm, or about 10 mm toabout 25 mm, or about 25 mm to about 40 mm.

In some embodiments, the anchor feet 220 a, 220 b, 220 c, and 220 d havea height ranging from about 8 mm to about 12 mm, or more than about 12mm. In some embodiments, the anchor feet 220 a, 220 b, 220 c, and 220 dhave a gutter engaging surface area (when fabric covered) ranging fromabout 6 mm² to about 24 mm². In some embodiments, the anchor feet 220 a,220 b, 220 c, and 220 d each have essentially the same gutter engagingsurface area. In particular embodiments, one or more of the anchor feet220 a, 220 b, 220 c, and 220 d has a different gutter engaging surfacearea than one or more of the other anchor feet 220 a, 220 b, 220 c, and220 d. The anchor feet 220 a, 220 b, 220 c, and 220 d can have widthsranging within about 1.5 mm to about 4.0 mm or more, and lengths rangingwithin about 3 mm to about 6 mm or more. The anchor feet 220 a, 220 b,220 c, and 220 d are sized and shaped so that the anchor assembly 200does not significantly impair the natural function of mitral valvechordae tendineae, the native mitral valve leaflets, and papillarymuscles even after the anchor assembly is anchored at the mitral valvesite.

As described previously, the anchor assembly 200 is designed to avoidinterference with the functioning of the native mitral valve 17.Therefore, the anchor assembly 200 can be implanted within the nativemitral valve 17 some time prior to the deployment therein of areplacement valve assembly, without degradation of valve 17 functionduring the period of time between the anchor implantation and the valveimplantation (whether that time is on the order of minutes, or evenseveral days or months). To avoid such interference between the anchorassembly 200 and the native mitral valve 17, the inter-annularconnections 270 a, 270 b, 270 c, and 270 d pass through the coaptationline 32 approximately. More particularly, the lateral anteriorinter-annular connection 270 a passes through the coaptation line 32adjacent to the anterolateral commissure 30 a. In like manner, themedial anterior inter-annular connection 270 d passes through thecoaptation line 32 adjacent to the posteromedial commissure 30 b. Insome implementations, the lateral posterior inter-annular connection 270b and medial posterior inter-annular connection 270 c pass through thenative mitral valve 17 in locations that are posteriorly biased from thenatural coaptation line 32. The posterior leaflet 22 will tend tocompliantly wrap around the lateral posterior inter-annular connection270 b and medial posterior inter-annular connection 270 c to facilitatesealing of the mitral valve 17, with the anchor assembly 200 coupledthereto.

In reference to FIGS. 9 and 10, the pre-deployed and deployedconfigurations of the SAM containment member 212 are illustratedrespectively. The deployed configuration of the SAM containment member212 (shown in FIG. 10) reveals that, in this embodiment, the lateralanterior arm 213 a and the medial anterior arm 213 d are conjoined, andthat an attachment element 214 (an eyelet 214 in this embodiment) isdisposed near the junction of the lateral anterior arm 213 a and themedial anterior arm 213 d. As described further below, the eyelet 214provides an attachment element that can be used to control theconfiguration and deployment of the SAM containment member 212. In someembodiments, other types of attachment elements 214 (as alternatives tothe eyelet 214) can be included on the SAM containment member 212. Forexample, in some embodiments one or more protrusions, ball ends,recesses, clips, breakable elements, deflectable elements, bends, andthe like, and combinations thereof, can be included on the SAMcontainment member 212 as an attachment element 214.

In the depicted embodiment, the SAM containment member 212 is biasedsuch that it naturally seeks to be arranged in the deployedconfiguration. Therefore, as described further below, in someembodiments when the SAM containment member 212 is released from beingconstrained in its pre-deployed configuration, the SAM containmentmember 212 will naturally reconfigure itself (or “self-reconfigure”)into the deployed configuration (or an approximation thereof). In someembodiments, a shape-setting process is used to instill a bias so thatthe SAM containment member 212 tends seek its deployed configuration.Alternatively or additionally, as described further below, in someembodiments the SAM containment member 212 may be deflected into thedeployed configuration by the application of one or more forces duringthe deployment of the SAM containment member 212.

In some implementations, while the SAM containment member 212 isdeployed, the lateral anterior arm 213 a and/or the medial anterior arm213 d may engage with the anterior leaflet and/or chordae to reduce thelikelihood of SAM. The engagement can be anywhere along the lengths ofthe lateral anterior arm 213 a and/or the medial anterior arm 213 d, andat the juncture thereof. For example, in some implementations portionsof the lateral anterior arm 213 a and/or the medial anterior arm 213 dthat are near to the lateral anterior sub-annular support arm 230 aand/or the medial anterior sub-annular support arm 230 d can actuallyengage the lateral edge of the anterior leaflet and/or chordae to spreador widen the anterior leaflet at the lateral edges thereby restrictingits movement and also reducing likelihood of SAM.

In reference to FIG. 11, the anchor assembly 200 may additionally oralternately include another example embodiment of a SAM containmentmember 216. In the depicted embodiment, the SAM containment member 216is fixedly attached to the hub 210, and extends in a generally anteriorand superior direction from the hub 210.

The SAM containment member 216 includes an arm portion 217 attached tothe hub 210, and an end portion 218 that extends from the arm portion217. While in the depicted embodiment the arm portion 217 is a singleelongate member, in some embodiments the arm portion 217 comprises twoor more elongate members.

In some embodiments, as in the depicted embodiment, the end portion 218extending from the elongate member arm portion 217 defines a width thatis greater than the width of the arm portion 217. As described furtherbelow, the end portion 218 is configured to be disposed behind ananterior leaflet when the anchor assembly 200 is engaged with a nativemitral valve. As used herein, “behind” an anterior leaflet refers to theaortic side of the native mitral valve leaflet when the leaflet is open.

In the depicted embodiment, the end portion 218 comprises a firstelongate member 219 a, a second elongate member 219 b, and a thirdelongate member 219 c (collectively referred to hereinafter as “threeelongate members 219 a-c”). The three elongate members 219 a-c fan outfrom the arm portion 217. The three elongate members 219 a-c therebycollectively define or encompass a broad area that will make contactwith the back of the anterior leaflet of a mitral valve in situ. In someembodiments, one or more interconnecting struts may extend between thethree elongate members 219 a-c. In some embodiments, the fanned outarrangement of the three elongate members 219 a-c is the natural orunconstrained arrangement of the three elongate members 219 a-c. Asdescribed further below, prior to the deployment of the SAM containmentmember 216, the three elongate members 219 a-c may be compressed towardseach other for containment within a lumen of a low-profile deliverysheath. Upon emergence from the lumen, the three elongate members 219a-c may naturally diverge from each other into the fanned outarrangement as shown.

While the depicted embodiment of the end portion 218 includes threeelongate members 219 a-c that extend from the arm portion 217 in afanned-out arrangement, various other configurations of the end portion218 are also envisioned. For example, in some embodiments a singleelongate member makes up the end portion 218. Such a single elongatemember may be wider, narrower, or the same width as the arm portion 217.In some embodiments, the end portion may have two elongate membersarranged in a V-shape or U-shape, and the like. In some embodiments, theend portion may include four or more elongate members. In someembodiments, the end portion may be a looped member, such as a circle,oval, triangle, rectangle, and the like. In some embodiments, the endportion 218 is generally planar. In some embodiments, the end portion218 is contoured rather than planar. As with the three elongate members219 a-c described above, other configurations of the end portion 218 canbe compressed for containment within a delivery sheath, and canself-expand into a larger (e.g., broader or wider) deployedconfiguration upon emergence from the delivery sheath.

While the three elongate members 219 a-c of the depicted embodiment ofthe end portion 218 each include bulbous free ends, in some embodimentsno such bulbous free ends are included. In the depicted embodiment, thebulbous free ends of the three elongate members 219 a-c include eyelets.However, in some embodiments no such eyelets are included.

In reference to FIG. 12, in some embodiments the anchor assembly 200includes a covering material 270 disposed on one or more portions of theanchor assembly 200. The covering material 270 can provide variousbenefits. For example, in some implementations the covering material 270can facilitate tissue ingrowth and/or endothelialization, therebyenhancing the migration resistance of the anchor assembly 200 andpreventing thrombus formation on blood contact elements. In anotherexample, as described further below, the covering material 270 can beused to facilitate coupling between the anchor assembly 200 and a valveassembly that is received therein. The cover material 270 also preventsor minimizes abrasion and/or fretting between the anchor assembly 200and valve assembly 300. The cover material 270 also prevents valve outertissue abrasion related wear, and supports to the cuff material toenhance durability. The covering material 270 may also provide redundantsealing in addition to the cuff material of the valve assembly.

In the depicted embodiment, the covering material 270 is disposedessentially on the entire anchor assembly 200, including the SAMcontainment member 212 (except for the eyelet 214, although in someembodiments the eyelet 214 may be essentially covered by the coveringmaterial 270). In some embodiments, the covering material 270 isdisposed on one or more portions of the anchor assembly 200, while oneor more other portions of the anchor assembly 200 do not have thecovering material 270 disposed thereon. While the depicted embodimentincludes the covering material 270, the covering material 270 is notrequired in all embodiments. In some embodiments, two or more portionsof covering material 270, which can be separated and/or distinct fromeach other, can be disposed on the anchor assembly 200. That is, in someembodiments a particular type of covering material 270 is disposed onsome areas of the anchor assembly 200 and a different type of coveringmaterial 270 is disposed on other areas of the anchor assembly 200.

In some embodiments, the covering material 270, or portions thereof,comprises a fluoropolymer, such as an expanded polytetrafluoroethylene(ePTFE) polymer. In some embodiments, the covering material 270, orportions thereof, comprises a polyester, a silicone, a urethane,ELAST-EON™ (a silicone and urethane polymer), another biocompatiblepolymer, DACRON®, polyethylene terephthalate (PET), copolymers, orcombinations and subcombinations thereof. In some embodiments, thecovering material 270 is manufactured using techniques such as, but notlimited to, extrusion, expansion, heat-treating, sintering, knitting,braiding, weaving, chemically treating, and the like. In someembodiments, the covering material 270, or portions thereof, comprises abiological tissue. For example, in some embodiments the coveringmaterial 270 can include natural tissues such as, but not limited to,bovine, porcine, ovine, or equine pericardium. In some such embodiments,the tissues are chemically treated using glutaraldehyde, formaldehyde,or triglycidylamine (TGA) solutions, or other suitable tissuecrosslinking agents.

In the depicted embodiment, the covering material 270 is disposed on theinterior and the exterior of the anchor assembly 200. In someembodiments, the covering material 270 is disposed on the just theexterior of the anchor assembly 200. In some embodiments, the coveringmaterial 270 is disposed on the just the interior of the anchor assembly200. In some embodiments, some portions of the anchor assembly 200 arecovered by the covering material 270 in a different manner than otherportions of the anchor assembly 200.

In some embodiments, the covering material 270 is attached to at leastsome portions of the anchor assembly 200 using an adhesive. In someembodiments, epoxy is used as an adhesive to attach the coveringmaterial 270 to the anchor assembly 200, or portions thereof. In someembodiments, wrapping, stitching, lashing, banding, and/or clips, andthe like can be used to attach the covering material 270 to the anchorassembly 200. In some embodiments, a combination of techniques are usedto attach the covering material 270 to the anchor assembly 200.

In some embodiments, the covering material 270, or portions thereof, hasa microporous structure that provides a tissue ingrowth scaffold fordurable sealing and/or supplemental anchoring strength of the anchorassembly 200. In some embodiments, the covering material 270 is made ofa membranous material that inhibits or reduces the passage of bloodthrough the covering material 270. In some embodiments, the coveringmaterial 270, or portions thereof, has a material composition and/orconfiguration that inhibits or prevents tissue ingrowth and/orendothelialization to the covering material 270.

In some embodiments, the covering material 270 can be modified by one ormore chemical or physical processes that enhance certain physicalproperties of the covering material 270. For example, a hydrophiliccoating may be applied to the covering material 270 to improve thewettability and echo translucency of the covering material 270. In someembodiments, the covering material 270 may be modified with chemicalmoieties that promote or inhibit one or more of endothelial cellattachment, endothelial cell migration, endothelial cell proliferation,and resistance to thrombosis. In some embodiments, the covering material270 may be modified with covalently attached heparin or impregnated withone or more drug substances that are released in situ.

In some embodiments, covering material 270 is pre-perforated to modulatefluid flow through the covering material 270 and/or to affect thepropensity for tissue ingrowth to the covering material 270. In someembodiments, the covering material 270 is treated to make the coveringmaterial 270 stiffer or to add surface texture. In some embodiments,selected portions of the covering material 270 are so treated, whileother portions of the covering material 270 are not so treated. Othercovering material 270 material treatment techniques can also be employedto provide beneficial mechanical properties and tissue responseinteractions. In some embodiments, portions of the covering material 270have one or more radiopaque markers attached thereto to enhance in vivoradiographic visualization.

Referring now to FIGS. 13A and 14A, the anchor assembly 200 is shownimplanted within a native mitral valve 17. FIGS. 13B and 14B arephotographs that correspond to FIGS. 13A and 14A respectively. In FIG.13A, the mitral valve 17 is shown in a closed state. In FIG. 14A, themitral valve 17 is shown in an open state. These illustrations are fromthe perspective of the left atrium looking towards the mitral valve 17.For instance, in FIG. 14A chordae tendineae 40 are visible through theopen leaflets of the mitral valve 17.

These figures illustrate the supra-annular structures and sub-annularstructures of the anchor assembly 200 in their relationships with thenative mitral valve 17. For example, the closed state of the nativemitral valve 17 in FIG. 13A allows visibility of the supra-annularstructures such as the lateral anterior atrial holding feature 240 a,the lateral posterior atrial holding feature 240 b, the medial posterioratrial holding feature 240 c, and the medial anterior atrial holdingfeature 240 d. In addition, the anterior anchor arch 250 a, the leftanchor arch 250 b, the posterior anchor arch 250 c, the right anchorarch 250 d, and the connection bridges 260 are visible. However, thesub-annular structures are not visible in FIG. 13A because suchstructures are obstructed from view by the anterior leaflet 20 and thethree-part posterior leaflet 24 a, 24 b, and 24 c.

In contrast, in FIG. 14A certain sub-annular structures of the anchorassembly 200 are visible because the native mitral valve 17 is open. Forexample, sub-annular support arms 230 a, 230 b, 230 c, and 230 d and hub210 are in view through the open mitral valve 17. Nevertheless, theanchor feet 220 a, 220 b, 220 c, and 220 d remain out of view because oftheir location within the sub-annular gutter of the mitral valve 17. Inaddition, no SAM containment member (which is a sub-annular structure)is visible in this view.

Referring to FIG. 15, after implantation of the anchor assembly 200within the native mitral valve 17 (as performed, for example, inaccordance with FIGS. 1-7 described above), a valve delivery sheath 170of the delivery system 100 can be used to deploy a valve assembly withinthe anchor assembly 200. As described above in reference to FIG. 7, withthe inner catheter 160 coupled with the hub 210 of the anchor assembly200, the inner catheter 160 can be used to guide the valve assembly intothe interior of the anchor assembly 200.

In the depicted embodiment, the SAM containment member 212 isconstrained in its pre-deployed configuration. However, in some otherSAM containment member embodiments, the SAM containment member may bedeployed prior to installation of a valve assembly within the anchorassembly 200. Generally speaking, depending on the SAM containmentmember embodiment's design, if the SAM containment member maypotentially interfere with the function of the anterior leaflet, it maybe preferable to wait until the valve is implanted to deploy the SAMcontainment member. But, if the SAM containment member does not or isunlikely to interfere with the leaflet function, the SAM containmentmember may be deployed prior to valve implant (which may be beneficialfor situations where the anchor is implanted in a separate procedurefrom the valve implantation).

In some implementations, with the guide catheter 120 positioned with itsdistal end in the left atrium 16, the valve delivery sheath 170 isinstalled into a lumen of the guide catheter 120 (over the innercatheter 160) and advanced through the guide catheter 120. As describedfurther below, in some embodiments the valve delivery sheath 170 ispreloaded with a prosthetic valve assembly and other components of thedelivery system 100. The guide catheter 120 may be the same catheterthat was used to deliver the anchor assembly 200, or it may be adifferent catheter (but still referred to here as the guide catheter 120for simplicity sake). Depending on the time interval betweenimplantation of the anchor assembly 200 and the valve assembly 300, itmay also be desirable to leave the same guide catheter 120 in situduring the time between the deliveries of each assembly.

In some embodiments, the valve delivery sheath 170 can be made from thematerials described above in reference to the guide catheter 120. Insome embodiments, the valve delivery sheath 170 has an outer diameter inthe range of about 20 Fr to about 28 Fr (about 6.7 mm to about 9.3 mm).In some embodiments, the valve delivery sheath 170 has an outer diameterin the range of about 14 Fr to about 24 Fr (about 4.7 mm to about 8.0mm).

In the depicted embodiment, the valve delivery sheath 170 includes aflared distal end portion 172. In some embodiments, no such flareddistal end portion 172 is included. The flared distal end portion 172can collapse to a lower profile when constrained within the guidecatheter 120. When the flared distal end portion 172 is expressed fromthe guide catheter 120, the flared distal end portion 172 canself-expand to the flared shape. In some embodiments, the material ofthe flared distal end portion 172 includes pleats or folds, may be acontinuous flared end or may be separated into sections such as flowerpedals, and may include one or more resilient elements that bias theflared distal end portion 172 to assume the flared configuration in theabsence of restraining forces (such as from containment within the guidecatheter 120). The flared distal end portion 172 can be advantageous,for example, for recapturing the valve assembly (if desired) within thelumen of the valve delivery sheath 170 after the valve assembly has beenexpressed from the flared distal end portion 172.

In some embodiments, the maximum outer diameter of the flared distal endportion 172 is in a range of about 30 Fr to about 34 Fr (about 10.0 mmto about 11.3 mm). In some embodiments, the maximum outer diameter ofthe flared distal end portion 172 is in a range of about 32 Fr to about44 Fr (about 10.7 mm to about 14.7 mm). In some embodiments, the maximumouter diameter of the flared distal end portion 172 is in a range ofabout 24 Fr to about 30 Fr (about 8.0 mm to about 10.0 mm). In someembodiments, the maximum outer diameter of the flared distal end portion172 is less than about 24 Fr (about 8.0 mm) or greater than about 44 Fr(about 14.7 mm).

Referring to FIG. 16, in some implementations the valve delivery sheath170 can be withdrawn into the guide catheter 120 while a valve deliverycatheter 180 is held substantially stationary to thereby express a valveassembly 300 from a lumen of the valve delivery sheath 170. The valvedelivery sheath 170 and the valve delivery catheter 180 are additionalcomponents in some embodiments of the example delivery system 100. Itshould be understood that movements of the components (e.g., the valvedelivery sheath 170 and the valve delivery catheter 180) of the deliverysystem 100, whether the movements be those of individual components ortwo or more components in combination with each other, can in someembodiments be initiated and controlled using a deployment frame system(such as the example deployment frame systems described below).

The valve assembly 300 can be releasably coupled to the valve deliverycatheter 180 and retained in a low-profile configuration. In someembodiments, both the distal and proximal ends of the valve assembly 300are releasably coupled to the valve delivery catheter 180. In someembodiments, just one of the distal end or the proximal end of the valveassembly 300 is releasably coupled to the valve delivery catheter 180.In particular embodiments, one or more control wires may be included toreleasably couple one or more portions of the valve assembly 300 to thevalve delivery catheter 180. In some such embodiments, the one or morecontrol wires may act as lassos to radially constrain the bias of thevalve assembly 300 to radially self-expand. Hence, a release of tensionon the one or more control wires may allow at least a portion of thevalve assembly 300 to radially self-expand.

Referring to FIGS. 17 and 18, the delivery system 100 can be manipulatedby a clinician operator to perform a lateral pivot (panning, rotation,etc.) of the valve assembly 300 within the left atrium 16. The rotationof the valve assembly 300 changes the alignment of the valve assembly300 from being generally axial with the distal end portion of the guidecatheter 120 to being generally axial with the anchor assembly 200 (inpreparation for installation of the valve assembly 300 into the interiorof the anchor assembly 200).

In some implementations, the aforementioned rotation of the valveassembly 300 can be performed as follows. As shown in FIG. 17, becauseof the influence from the guide catheter 120 on the valve deliverycatheter 180, the axis of the valve assembly 300 is initially in generalalignment with the axis of the distal end portion of the guide catheter120. From this arrangement, a generally simultaneous counter-movementof/between the inner catheter 160 and the valve delivery catheter 180can be performed by the clinician to rotate the valve assembly 300. Thatis, as the inner catheter 160 is pulled proximally, the valve deliverycatheter 180 is pushed distally. As a result of that counter movement,the valve assembly 300 rotates/pans in a relatively tight radius withinthe left atrium 16, as required by the confines of the left atrium 16.Thereafter, the valve delivery catheter 180 can be advanced further sothat the valve assembly 300 is coaxially positioned within the interiorof the anchor assembly 200 as shown in FIG. 18. As with other movementsof the components of the delivery system 100 described herein (and othermovements of the components of the delivery system 100 that are likethose described herein), the generally simultaneous counter-movementsof/between the inner catheter 160 and the valve delivery catheter 180can be initiated and controlled using a deployment frame system (such asthe example deployment frame systems described below) in someimplementations.

Referring now also to FIG. 19, in some embodiments the valve assembly300 and the anchor assembly 200 become aligned with each othercoaxially, linearly (along their axes), and rotationally prior to orduring the expansion of the valve assembly 300, resulting in engagementbetween the valve assembly 300 and the anchor assembly 200.

Coaxial alignment between the valve assembly 300 and the anchor assembly200, as described above, is achieved by virtue of the valve deliverycatheter 180 being slidably disposed over the inner catheter 160. Linearalignment between the valve assembly 300 and the anchor assembly 200 canbe achieved by the interaction of a distal end feature 182 of the valvedelivery catheter 180 and the hub 210 of the anchor assembly 200. Forexample, in some embodiments an abutting of the distal end feature 182and the hub 210 can result in proper linear alignment between the valveassembly 300 and the anchor assembly 200. Such abutting of the distalend feature 182 and the hub 210 can be attained by translating the valvedelivery catheter 180 distally until the distal end feature 182 abutsthe hub 210.

Relative rotational alignment between the valve assembly 300 and theanchor assembly 200 (about their longitudinal axes) can be achieved invarious manners. For example, in some embodiments the valve deliverycatheter 180 is mechanically keyed to the inner catheter 160 to slidablyfix a desired rotational alignment between the valve assembly 300 andthe anchor assembly 200. In some embodiments, other types of mechanicalfeatures (e.g., pins/holes, protrusions/receptacles, etc.) can beincluded to facilitate a desired rotational/spin alignment between thevalve assembly 300 and the anchor assembly 200. Alternatively, oradditionally, radiopaque markers can be included on the valve assembly300 and on the anchor assembly 200 (including on the SAM containmentmember) in locations and/or patterns that are indicative of the relativerotational orientation (about their axes) of the valve assembly 300 andthe anchor assembly 200. In some embodiments (e.g., when the valvedelivery catheter 180 is configured to be “torqueable”), the valvedelivery catheter 180 can be rotated about its longitudinal axis untilthe radiopaque markers are in proper position relative to the anchorassembly 200, prior to final expansion of valve assembly 300. Suchrotation of the valve delivery catheter 180 can, in someimplementations, be initiated and controlled using a deployment framesystem (such as the example deployment frame systems described below).Fluoroscopy can be used to attain a desired relative orientation of theradiopaque markers, and of the valve assembly 300 and the anchorassembly 200 (including on the SAM containment member) correspondingly.

In the depicted implementation, the SAM containment member 212 is stillin its pre-deployed configuration. Therefore, the depicted embodiment ofthe SAM containment member 212 is deployed after the valve assembly 300is engaged within the anchor assembly 200. However, for some alternativeembodiments of the SAM containment member (as described further below)the SAM containment member is deployed prior to the engagement of thevalve assembly 300 within the anchor assembly 200.

After proper alignment between the valve assembly 300 and the anchorassembly 200 is achieved, the valve assembly 300 can be expanded withinthe interior of the anchor assembly 200 such that the valve assembly 300and anchor assembly 200 become releasably coupled to each other. In someembodiments, force(s) are applied to the valve assembly 300 to cause itto expand. In some embodiments, the valve assembly 300 is biased toself-expand. The expansion of a self-expanding valve assembly 300 can beinitiated by releasing tension on the one or more control wires of thevalve delivery catheter 180. For example, in some embodiments the valvedelivery catheter 180 includes a first control wire that restrains theproximal end portion of the valve assembly 300, and a second controlwire that restrains the distal end portion of the valve assembly 300. Astension on the first control wire is released, the proximal end portionof the valve assembly 300 is allowed to radially expand. Similarly, astension on the second control wire is released, the distal end portionof the valve assembly 300 is allowed to radially expand. The expansionsof the portions of the valve assembly 300 may be allowed to take placesequentially, concurrently, or partially concurrently. As describedfurther below, such individual and/or simultaneous movements ofcomponents of the delivery system 100 (such as the one or more controlwires of the valve delivery catheter 180) can be initiated andcontrolled using a deployment frame system (such as the exampledeployment frame systems described below) in some implementations.

After the valve assembly 300 has been expanded into a coupledrelationship with the anchor assembly 200, the clinician can verify thatthe anchor assembly 200 and the valve assembly 300 are in the desiredpositions. Additionally, the clinician may verify other aspects such as,but not limited to, the hemodynamic performance and sealing of theanchor assembly 200 and the valve assembly 300.

In some embodiments, the SAM containment member 212 is deployed afterthe valve assembly 300 has been expanded into a coupled relationshipwith the anchor assembly 200. To deploy the SAM containment member 212,in some embodiments the inner catheter 160 is rotated about itslongitudinal axis so that the distal end of the inner catheter 160 isunthreaded from the hub 210 of the anchor assembly 200. Then, in someembodiments the guidewire 110 is retracted to allow full deployment ofthe SAM containment member 212

With the valve assembly 300 and the anchor assembly 200 fully deployedand functioning as desired, the remaining components of the deliverysystem 100 can be withdrawn. To do so, the valve delivery catheter 180and the inner catheter 160 can be retracted into the guide catheter 120.Then the valve delivery catheter 180, the inner catheter 160, and theguide catheter 120 can be jointly or individually withdrawn from thepatient.

Referring to FIGS. 20 and 21, an example valve assembly 300 is shownwithout any covering or valve/occluder leaflets. Hence, a valve assemblyframe 301 of the valve assembly 300 is shown. FIG. 20 shows an anteriorside view of the valve assembly frame 301, and FIG. 21 shows a bottomview of the valve assembly frame 301. The valve assembly 300 can beconstructed using any of the various materials and manufacturingtechniques described above in reference to the anchor frame 200 (e.g.,refer to FIG. 9). It should be understood that the depicted valveassembly 300 is merely one non-limiting example of the valve assembliesprovided within the scope of this disclosure.

The valve assembly 300 includes a proximal end portion 302 and a distalend portion 304. The valve assembly includes a flared external skirtportion 303 and defines an interior orifice portion 305. When the valveassembly 300 is implanted in a native mitral valve, the proximal endportion 302 is located supra-annular (in the left atrium) and the distalend portion 304 is located sub-annular (in the left ventricle). Theproximal end portion 302 defines the generally circular entrance orificeof the valve assembly 300, as described further below.

In the depicted embodiment, the valve assembly 300 generally flaresoutward along a distal direction. Said differently, the distal endportion 304 is flared outward in comparison to the proximal end portion302. Accordingly, the proximal end portion 302 defines a smaller outerprofile in comparison to the distal end portion 304. However, someregions of the distal end portion 304 bow inwardly. In particular, forexample, a posteromedial commissural corner 330 a and anterolateralcommissural corner 330 b of the valve assembly 300 may bow inwardly. Itshould be understood that the outward flare of the distal end portion304 in comparison to the proximal end portion 302 is merely one exampleconfiguration for a profile of the valve assembly 300. In someembodiments, for example, a shoulder (a portion of the valve assembly300 having the largest outer periphery) is located proximal of themiddle of the valve assembly 300.

The valve assembly 300 also includes an anterior side 306 between theposteromedial commissural corner 330 a and anterolateral commissuralcorner 330 b. When the valve assembly 300 is implanted in a nativemitral valve, the anterior side 306 faces the anterior leaflet of thenative mitral valve. The anterior side 306 of the distal end portion 304defines a generally flat surface, whereas the other sides of the distalend portion 304 are rounded. Hence, the periphery of the distal endportion 304 is generally D-shaped. The D-shaped periphery of the distalend portion 304 provides the valve assembly 300 with an advantageousouter profile for interfacing and sealing with the native mitral valve.As described further below, sealing is attained by coaptation betweenthe D-shaped periphery of the distal end portion 304 and the leaflets ofthe native mitral valve, and, in some embodiments, between the D-shapedperiphery in the region of the skirt 303 with the native valve annulus.

In the depicted embodiment, the proximal end portion 302 of the valveassembly 300 includes three atrial leaflet arches 310 a, 310 b, and 310c that together define an undulating ring at the proximal end portion302. Each of the leaflet arches 310 a, 310 b, and 310 c includes an apexhaving an attachment hole 312 a, 312 b, and 312 c respectively. In someembodiments, the attachment holes 312 a, 312 b, and 312 c are used forcoupling the proximal end of the valve assembly 300 to a deliverycatheter (e.g., valve delivery catheter 180 of FIGS. 16-18).

The valve assembly 300 also includes three commissural posts 320 a, 320b, and 320 c that each extend distally from the intersections of thethree leaflet arches 310 a, 310 b, and 310 c. The commissural posts 320a, 320 b, and 320 c are disposed at about 120° apart from each other.The commissural posts 320 a, 320 b, and 320 c each have a series ofholes that can be used for attachment of leaflets, such as by suturing.The three leaflet arches 310 a, 310 b, and 310 c and the threecommissural posts 320 a, 320 b, and 320 c are areas on the valveassembly 300 to which three prosthetic valve leaflets become attached tocomprise a tri-leaflet occluder (e.g., refer to FIGS. 23-26).

As seen in FIG. 21, the three leaflet arches 310 a, 310 b, and 310 c andthe commissural posts 320 a, 320 b, and 320 c define a generallycylindrical frame for the tri-leaflet occluder construct. As such, thevalve assembly 300 provides a proven and advantageous frameconfiguration for the tri-leaflet occluder. The tri-leaflet occluderprovides open flow during diastole and occlusion of flow during systole.

Referring to FIG. 22, an exploded depiction of an example prostheticmitral valve 400 includes an anchor assembly 200 and a valve assembly300. This figure provides a posterior side view of the anchor assembly200 and the valve assembly 300.

The valve assembly 300 includes a covering 340. The covering 340 can bemade of any of the materials and constructed using any of the techniquesdescribed above in reference to covering 270. Additionally, in someembodiments the covering 340 can comprise natural tissues such as, butnot limited to, bovine, porcine, ovine, or equine pericardium. In somesuch embodiments, the tissues are chemically cross-linked usingglutaraldehyde, formaldehyde, or triglycidyl amine solution, or othersuitable crosslinking agents.

When the valve assembly 300 and the anchor assembly 200 are coupledtogether, the valve assembly 300 is geometrically interlocked within theinterior of the anchor assembly 200 (e.g., in some embodiments by virtueof the tapered shape of the valve assembly 300 within the supra-annularring and interior space of the anchor assembly 200). In particular, insome embodiments the valve assembly 300 is contained within the interiorspace between the supra-annular ring 250 and the sub-annular supportarms 230 a, 230 b, 230 c, and 230 d. As described above, the interlockedarrangement between the valve assembly 300 and the anchor assembly 200is accomplished by positioning a valve assembly 300 in a low-profileconfiguration within the interior of the anchor assembly 200 and thenallowing expansion of the valve assembly 300 within the interior of theanchor assembly 200 (e.g., refer to FIGS. 18 and 19).

Referring to FIGS. 23 and 24, a deployed configuration of the exampleprosthetic mitral valve 400 includes the valve assembly 300 engagedwithin the anchor assembly 200. FIG. 23 shows a top (atrial) view of theprosthetic mitral valve 400, and FIG. 24 shows a bottom (ventricle) viewof the prosthetic mitral valve 400.

In some embodiments, such as the depicted embodiment, valve assembly 300includes three leaflets 350 a, 350 b, and 350 c that perform theoccluding function of the prosthetic mitral valve 400. The cusps of thethree leaflets 350 a, 350 b, and 350 c are fixed to the three atrialleaflet arches 310 a, 310 b, and 310 c, and to the three commissuralposts 320 a, 320 b, and 320 c (refer to FIGS. 20 and 21). The free edgesof the three leaflets 350 a, 350 b, and 350 c can seal by coaptationwith each other during systole and open during diastole.

The three leaflets 350 a, 350 b, and 350 c can be comprised of naturalor synthetic materials. For example, the three leaflets 350 a, 350 b,and 350 c can be comprised of any of the materials described above inreference to the covering 340, including the natural tissues such as,but not limited to, bovine, porcine, ovine, or equine pericardium. Insome such embodiments, the tissues are chemically cross-linked usingglutaraldehyde, formaldehyde, or triglycidyl amine solution, or othersuitable crosslinking agents. In some embodiments, the leaflets 350 a,350 b, and 350 c have a thickness in a range of about 0.005″ to about0.020″ (about 0.13 mm to about 0.51 mm), or about 0.008″ to about 0.012″(about 0.20 mm to about 0.31 mm). In some embodiments, the leaflets 350a, 350 b, and 350 c have a thickness that is less than about 0.005″(about 0.13 mm) or greater than about 0.020″ (about 0.51 mm).

In some embodiments, the occluding function of the prosthetic mitralvalve 400 can be performed using configurations other than a tri-leafletoccluder. For example, bi-leaflet, quad-leaflet, or mechanical valveconstructs can be used in some embodiments.

In some embodiments, a SAM containment member is included as part of theanchor assembly 200 (e.g., refer to FIGS. 10 and 11). In the depictedembodiment, no SAM containment member is included.

Referring to FIGS. 25 and 26, the prosthetic mitral valve 400 is shownimplanted within a native mitral valve 17. In FIG. 25, the prostheticmitral valve 400 is shown in a closed state (occluded). In FIG. 26, theprosthetic mitral valve 400 is shown in an open state. Theseillustrations are from the perspective of the left atrium lookingtowards the mitral valve 17. For instance, in FIG. 26 the hub 210 andthe sub-annular support arms 230 a, 230 b, 230 c, and 230 d of theanchor assembly 200 are visible through the open leaflets 350 a, 350 b,and 350 c of the prosthetic mitral valve 400, whereas in FIG. 25 the hub210 and the sub-annular support arms 230 a, 230 b, 230 c, and 230 d arenot visible because the closed leaflets 350 a, 350 b, and 350 c blockthe hub 210 from view.

Referring to FIG. 27, in some implementations the prosthetic mitralvalve 400 is deployed in a patient 1 using the transcatheter deliverysystem 100 as described above. In some implementations, the prostheticmitral valve 400 is percutaneously deployed via a femoral or iliac veinthrough a groin opening/incision 2 in the patient 1. In particularimplementations, a deployment frame system 6 is used to initiate and/orcontrol the movements of various components of the transcatheterdelivery system 100.

While the deployment frame systems provided herein are described in thecontext of the deployment of the prosthetic mitral valve 400 using thetranscatheter delivery system 100, it should be understood that thepractical applications of the inventive concepts associated with thedeployment frame systems provided herein are not limited to such acontext. That is, the inventive concepts associated with the deploymentframe systems provided herein can be applied to contexts such as, butnot limited to, other types of delivery systems for prosthetic heartvalves of any type, deployment systems for other types of medicaldevices/implants, and so on.

In the depicted embodiment, the deployment frame system 6 is attached orreleasably attached to an operating table 4 on which the patient 1 islaying. In some embodiments, the deployment frame system 6 is separatedor substantially separated from the operating table 4.

As described above in reference to FIGS. 1-7 and 15-19, the deploymentof the prosthetic mitral valve 400 is, in summary, a two-step process.The first step is the deployment of the anchor assembly 200, and thesecond step is the deployment of the valve assembly 300. As describedfurther below, some components of the deployment frame systems providedherein may be used for both steps, while other components of thedeployment frame systems provided herein may be used for one or theother of the two steps.

In general, the configurations of the deployment frame systems 6provided herein are different for the two deployment steps (i.e., thefirst step being the deployment of the anchor assembly 200, and thesecond step being the deployment of the valve assembly 300). That is,the configuration of the deployment frame system 6 for delivering theanchor assembly 200 is different than the configuration of thedeployment frame system 6 for delivering the valve assembly 300.

Referring to FIG. 28A, an example deployment frame system 500 can beconfigured to deploy a prosthetic mitral valve anchor assembly 200(refer to FIGS. 1-14B) using the transcatheter delivery system 100.While the depicted deployment frame system 500 is configured fordeploying the anchor assembly 200, it should be understood that thiscontext is one illustrative example of how the inventive conceptsprovided herein can be implemented. That is, the inventive conceptsdescribed in the context of deployment frame system 500 can be adaptedand implemented for the percutaneous deployment of many other types ofprosthetic implants, medical devices, and the like, either viapercutaneous, endovascular, minimally invasive, or open surgicalprocedures, and the like.

The deployment frame system 500 can be implemented, for example, asgenerally depicted in FIG. 27. That is, in some embodiments deploymentframe system 500 can be affixed to an operating table 4 (or another typeof mounting base), in a desired positional relationship with a patient1. For example, in some implementations deployment frame system 500 ispositioned relative to the patient 1 so that the implantable device(e.g., example prosthetic mitral valve 400) is percutaneously insertedinto a femoral or iliac vein via a groin incision 2 in a patient 1.

Referring also to FIG. 28B, transcatheter delivery system 100 can bereleasably coupled with deployment frame system 500, as describedfurther below. The deployment frame system 500 can be used by one ormore clinicians to initiate and control movements of the components ofthe delivery system 100. Some such movements of the components of thedelivery system 100 are described above in reference to FIGS. 1-7 and15-19.

As described above, the example transcatheter delivery system 100includes the guidewire 110, the guide catheter 120, the anchor deliverysheath 130, the anchor delivery catheter 140, the secondary steerablecatheter 150, and the inner catheter 160. In general, in the depictedembodiment those components of delivery system 100 are disposed in atelescopic fashion in relation to each other. That is, the guidewire 110is slidably disposed within the inner catheter 160; the inner catheter160 is slidably disposed within the secondary steerable catheter 150;the secondary steerable catheter 150 is slidably disposed within theanchor delivery catheter 140; the anchor delivery catheter 140 isslidably disposed within the anchor delivery sheath 130; and the anchordelivery sheath 130 is slidably disposed within the guide catheter 120.

A proximal end portion of each of those components (the guidewire 110,the guide catheter 120, the anchor delivery sheath 130, the anchordelivery catheter 140, the secondary steerable catheter 150, and theinner catheter 160) is terminated at a respective location along thedeployment frame system 500. As described further below, by manipulatingthe respective components' proximal end portions (individually or inunison) using the deployment frame system 500, clinicians can initiateand control movements of the delivery system 100.

The example deployment frame system 500 includes a main frame 510, asecondary frame 520, a guide catheter control assembly 530, an anchordelivery sheath control assembly 540, an anchor delivery cathetercontrol assembly 550, a secondary steerable catheter control assembly560, an inner catheter control assembly 570, and a guidewire controlassembly 580. Each of the guide catheter control assembly 530, theanchor delivery sheath control assembly 540, the anchor deliverycatheter control assembly 550, the secondary steerable catheter controlassembly 560, the inner catheter control assembly 570, and the guidewirecontrol assembly 580 is releasably coupled to the main frame 510. Inaddition, the anchor delivery sheath control assembly 540, the anchordelivery catheter control assembly 550, the secondary steerable cathetercontrol assembly 560, and the inner catheter control assembly 570 arealso releasably coupled to the secondary frame 510. In someimplementations of deployment frame system 500 for deploying the anchorassembly 200, no inner catheter control assembly 570 is included.Rather, the inner catheter 160 can be floating on the guidewire 110.

In the depicted embodiment, the proximal end of the guide catheter 120terminates at the guide catheter control assembly 530, which isreleasably coupled to the main frame 510. Proximal end portions of othercomponents of the delivery system (e.g., the anchor delivery sheath 130,the anchor delivery catheter 140, the secondary steerable catheter 150,the inner catheter 160, and the guidewire 110) extend proximally pastthe guide catheter control assembly 530 (by virtue of the othercomponents' telescopic relationship to the guide catheter 120).

In the depicted embodiment, the proximal end of the anchor deliverysheath 130 terminates at the anchor delivery sheath control assembly540, which is releasably coupled to the main frame 510 and to thesecondary frame 520. Proximal end portions of other components of thedelivery system (e.g., the anchor delivery catheter 140, the secondarysteerable catheter 150, the inner catheter 160, and the guidewire 110)extend proximally past the anchor delivery sheath control assembly 540(by virtue of the other components' telescopic relationship to theanchor delivery sheath 130).

In the depicted embodiment, the proximal end of the anchor deliverycatheter 140 terminates at the anchor delivery catheter control assembly550, which is releasably coupled to the main frame 510 and to thesecondary frame 520. Proximal end portions of other components of thedelivery system (e.g., the secondary steerable catheter 150, the innercatheter 160, and the guidewire 110) extend proximally past the anchordelivery catheter control assembly 550 (by virtue of the othercomponents' telescopic relationship to the anchor delivery catheter140).

In the depicted embodiment, the proximal end of the secondary steerablecatheter 150 terminates at the secondary steerable catheter controlassembly 560, which is releasably coupled to the main frame 510 and tothe secondary frame 520. Proximal end portions of other components ofthe delivery system (e.g., the inner catheter 160, and the guidewire110) extend proximally past the secondary steerable catheter controlassembly 560 (by virtue of the other components' telescopic relationshipto the secondary steerable catheter 150).

In the depicted embodiment, the proximal end of the inner catheter 160terminates at the inner catheter control assembly 570, which isreleasably coupled to the main frame 510 and to the secondary frame 520.A proximal end portion of the guidewire 110 extends proximally past theinner catheter control assembly 570 (by virtue of the guidewire'stelescopic relationship to the inner catheter 160).

In the depicted embodiment, a proximal end portion of the guidewire 110extends through (e.g., releasably clamped) the guidewire controlassembly 580, which is releasably coupled to the main frame 510.

As described above in reference to FIGS. 1-7 and 15-19, variousmovements of the components of the delivery system 100 may be desiredduring the process of deploying (or retrieving) a medical device, suchas the anchor assembly 200 and valve assembly 300 of prosthetic mitralvalve 400 (refer to FIG. 22). For example, the types of desiredmovements of the components of the delivery system 100 may include, butare not limited to: (i) a distal longitudinal translation, (ii) aproximal longitudinal translation, (iii) rotations about thelongitudinal axis in either direction, (iv) a deflection of one or moreportions of a component (e.g., steering or bending), and (v) atensioning or untensioning of a control wire.

In some implementations, it may be desirable to initiate some of suchmovements (e.g., example movements (i)-(v) above) in synchronization(e.g., generally simultaneously) with one or more other such movements.One example, of desirable simultaneous movement of two or morecomponents of the delivery system 100 was described above in referenceto FIG. 4. In that example, the inner catheter 160 and the anchordelivery catheter 140 were translated distally in conjunction with eachother, while maintaining the positions of the other components of thedelivery system 100 (e.g., the secondary steerable catheter 150)generally stationary. As described further below, the secondary frame520 can be advantageously utilized to facilitate such synchronization ofmovements of two or more components of the delivery system 100.

Referring also to FIG. 28C, in the depicted embodiment of the deploymentframe system 500 each control assembly (e.g., the guide catheter controlassembly 530, the anchor delivery sheath control assembly 540, theanchor delivery catheter control assembly 550, the secondary steerablecatheter control assembly 560, the inner catheter control assembly 570,and the guidewire control assembly 580) is releasably coupled to one orboth of the main frame 510 and the secondary frame 520. For example, thesecondary steerable catheter control assembly 560 is coupled to both themain frame 510 and the secondary frame 520. In particular, the secondarysteerable catheter control assembly 560 is coupled to the main frame 510via a clamp base 561 and a pivotable toggle clamp 562. An upward ordownward pivoting motion of the toggle clamp 562 effectuates anunlocking and a locking of the clamp base 561 in relation to the mainframe 510. The toggle clamp 562 (and other toggle clamps describedherein) may include a cam profile surface that can be pivoted into placeto create a friction fit between two components that effectively locksthe two components together. Moreover, in the depicted embodiment thesecondary steerable catheter control assembly 560 is also coupled to thesecondary frame 520, via the clamp base 561 and a pivotable toggle clamp563. An upward or downward pivoting motion of the toggle clamp 563effectuates an unlocking and a locking of the clamp base 561 in relationto the secondary frame 520. When the secondary steerable cathetercontrol assembly 560 is unlocked from both the main frame 510 and thesecondary frame 520, the secondary steerable catheter control assembly560 is essentially free to be translated (e.g., slid) distally orproximally in relation to both the main frame 510 and the secondaryframe 520.

In the depicted embodiment, the other control assemblies (e.g., theguide catheter control assembly 530, the anchor delivery sheath controlassembly 540, the anchor delivery catheter control assembly 550, theinner catheter control assembly 570, and the guidewire control assembly580) are similarly releasably coupled to one or both of the main frame510 and the secondary frame 520. For example, the inner catheter controlassembly 570 is releasably coupled to both the main frame 510 and thesecondary frame 520. In particular, the inner catheter control assembly570 is coupled to the main frame 510 via a clamp base 571 and apivotable toggle clamp 572. An upward or downward pivoting motion of thetoggle clamp 572 effectuates an unlocking and a locking of the clampbase 571 in relation to the main frame 510. Moreover, in the depictedembodiment the inner catheter control assembly 570 is also coupled tothe secondary frame 520, via the clamp base 571 and a pivotable toggleclamp 573. An upward or downward pivoting motion of the toggle clamp 573effectuates an unlocking and a locking of the clamp base 571 in relationto the secondary frame 520. When the inner catheter control assembly 570is unlocked from both the main frame 510 and the secondary frame 520,the inner catheter control assembly 570 is essentially free to betranslated (e.g., slid) distally or proximally in relation to both themain frame 510 and the secondary frame 520.

While in the depicted embodiment the control assemblies 530, 540, 550,560, 570, and 580 are releasably coupled to one or both of the mainframe 510 and the secondary frame 520 using a toggle clamp mechanism, itshould be understood that additionally, or alternatively, other types ofmechanisms can be used. For example, in some embodiments mechanisms suchas, but not limited to, spring detents, set screws, collar clamps, gears(e.g., a rack and pinion), pins, and the like, can be used.

One of skill in the art will recognize that various individual and/orgroup movements of the control assemblies 530, 540, 550, 560, 570, and580 can be facilitated by locking and/or unlocking the couplings ofparticular ones of the control assemblies 530, 540, 550, 560, 570, and580 from one or both of the main frame 510 and the secondary frame 520,as described in the following example.

To distally translate the anchor delivery catheter 140 and the innercatheter 160 in conjunction with each other, while maintaining thepositions of the other components of the delivery system 100 stationary(i.e., to facilitate the movement described above in reference to FIG.4) the clinician can perform the following actions. To start with, allthe clamps are in their locked configurations. The clamp 552 that locksthe anchor delivery catheter control assembly 550 to the main frame 510,and the clamp 572 that locks the inner catheter control assembly 570 tothe main frame 510 should both be unlocked. With clamps 552 and 572unlocked, the anchor delivery catheter control assembly 550 and theinner catheter control assembly 570 are free to be moved in relation tothe main frame 510. Then, the clamp 543 that locks the anchor deliverysheath control assembly 540 to the secondary frame 520, and the clamp563 that locks the secondary steerable catheter control assembly 560 tothe secondary frame 520 should both be unlocked (leaving the anchordelivery catheter 140 and inner catheter 160 both secured to thesecondary frame 520). With the clamps 543 and 563 unlocked, thesecondary frame 520 is free to move in relation to the anchor deliverysheath control assembly 540 and the secondary steerable catheter controlassembly 560. Now, a movement of either the anchor delivery cathetercontrol assembly 550 or the inner catheter control assembly 570 willresult in synchronous movement of both the inner catheter 160 and theanchor delivery catheter 140, while the other components of the deliverysystem 100 remain generally stationary. This synchronous movement ofboth the inner catheter 160 and the anchor delivery catheter 140 isfacilitated by the secondary frame 520. That is, the secondary frame 520is used to lock the anchor delivery catheter control assembly 550 andthe inner catheter control assembly 570 in fixed positions relation toeach other.

Referring to FIG. 29A, a schematic depiction of an example cathetersystem 600 coupled to an example deployment system 700 will now be usedto further illustrate the functionality of the deployment frame systemsprovided herein.

Catheter system 600 includes a plurality of component devices such ascatheters 610, 620, 630, 640, 650, and 660 that are slidably coupledwith each other as depicted. It should be understood that cathetersystem 600 is merely an illustrative example, and that the deploymentframe systems provided herein can be used with many other types ofcatheter systems that have other numbers and/or types of componentdevices.

Deployment system 700 includes a plurality of component devices such asa main frame 710, a secondary frame 720, and couplings 730, 740, 750,760, 770, and 780. It should be understood that deployment system 700 ismerely an illustrative example, and that the deployment frame systemsprovided herein can, alternately or additionally, be designed to includeother types of component devices and to be arranged in differentconfigurations.

Coupling 730 is releasably fixed to catheter 660 and main frame 710 (butnot to secondary frame 720). Coupling 740 is releasably fixed tocatheter 650, to main frame 710, and to secondary frame 720. Coupling750 is releasably fixed to catheter 640, to main frame 710, and tosecondary frame 720. Coupling 760 is releasably fixed to catheter 630,to main frame 710, and to secondary frame 720. Coupling 770 isreleasably fixed to catheter 620, to main frame 710, and to secondaryframe 720. Coupling 780 is releasably fixed to catheter 610 and mainframe 710 (but not to secondary frame 720).

In the schematic depiction, a circle containing an “x” indicates thatthe respective coupling is locked (affixed) to the respective othercomponent. In contrast, an open circle indicates that the respectivecoupling is not locked (not affixed) to the respective other component(i.e., the respective coupling and respective other coupling are free tomove in relation to each other). In FIG. 29A, each of the couplings 730,740, 750, 760, 770, and 780 is locked with one catheter 660, 650, 640,630, 620, and 610 (respectively). In addition, each of the couplings730, 740, 750, 760, 770, and 780 is locked with the main frame 710.Lastly, couplings 740, 750, 760, and 770 are also locked with thesecondary frame 720.

Referring also to FIG. 29B, in a first example the deployment system 700can be configured to facilitate movement of a single coupling/catheter.In this example, coupling 740 and catheter 650 are depicted asundergoing a proximal translational movement. To facilitate thismovement, coupling 740 is unlocked from each of the main frame 710 andthe secondary frame 720. Hence, the coupling 740 (and the catheter 650to which the coupling 740 is affixed) are free to move relative to themain frame 710 and to the secondary frame 720. Arrows 651 and 741represent the proximal movements of the catheter 650 and the coupling740 respectively. It can be seen that the main frame 710 and thesecondary frame 720 are stationary, while the catheter 650 and thecoupling 740 move proximally in relation to the main frame 710 and thesecondary frame 720. All of the other couplings and catheters (otherthan the catheter 650 and the coupling 740) are also stationary, whilethe catheter 650 and the coupling 740 move proximally in relation to allof the other couplings and catheters. It should be understood that thisillustrative example can be extrapolated such that movements of one ormore of the other couplings/catheters can be activated and controlled.

Referring to FIG. 30A, the catheter system 600 and the deployment system700 are configured in another arrangement. As with the arrangement ofFIG. 29A, each of the couplings 730, 740, 750, 760, 770, and 780 islocked with one catheter 660, 650, 640, 630, 620, and 610(respectively). In addition, each of the couplings 730, 740, 750, 760,770, and 780 is locked with the main frame 710. Lastly, couplings 740,750, 760, and 770 are also locked with the secondary frame 720.

Referring also to FIG. 30B, in a second example the deployment system700 can be configured to facilitate the synchronous movement of agrouping of two couplings/catheters. In this example, the followingcomponents are depicted as undergoing a distal translational movement:(i) coupling 750 and catheter 640, (ii) coupling 770 and catheter 620,and (iii) secondary frame 720.

To facilitate the aforementioned movements, the following couplings areunlocked from a respective component: (a) coupling 740 is unlocked fromthe secondary frame 720, (b) coupling 750 is unlocked from the mainframe 710, (c) coupling 760 is unlocked from the secondary frame 720,and (d) coupling 770 is unlocked from the main frame 710. Hence,couplings 750 and 770 are free to move relative to the main frame 710,and the secondary frame 720 is free to move relative to couplings 740and 760.

As either one (or both) of couplings 750 and 770 are translated distally(such as by a manual force exerted by a clinician), all of the followingcomponents will undergo a distal translation: (i) coupling 750 andcatheter 640, (ii) coupling 770 and catheter 620, and (iii) secondaryframe 720. In this arrangement, the secondary frame 720 effectivelybecomes a rigid mechanical linkage that interlocks couplings 750 and 770together, while being free to move relative to the other couplings 740,760, and 780 (which remain stationary along with the main frame 710).

Arrows 751 and 771 represent the distal movements of the couplings 750and 770 respectively. Arrows 621 and 641 represent the distal movementsof the catheters 620 and 640 respectively. Arrow 721 represents thedistal movement of the secondary frame 720. It can be seen that the mainframe 710 and couplings 740, 760, and 780 are stationary, while thecatheters 640 and 620, couplings 750 and 770, and secondary frame 720move distally in relation thereto. It should be understood that conceptsillustrated in this example can be extrapolated to one or more of theother couplings/catheters such that synchronous movements of variousother groupings of delivery system components can be activated andcontrolled.

Referring again to FIGS. 28A-28C, in additional to facilitating distaland/or proximal translational movements of various individual componentsor groups of components of the delivery system 100, the deployment framesystem 500 can facilitate other types of movements of the components ofthe delivery system 100. For example, the other types of movements ofthe components of the delivery system 100 may include, but are notlimited to: (i) rotations about the longitudinal axis in eitherdirection, (ii) a deflection (e.g., steering or bending) of one or moreportions of a component, and (iii) a tensioning or untensioning ofcontrol wires.

An example technique for facilitating rotations of a component of thedelivery system 100 about its longitudinal axis will now be explained.As seen in FIG. 28C, the proximal portion of the secondary steerablecatheter 150 is releasably coupled within a clamp collar 564 of thesecondary steerable catheter control assembly 560. The clamp collar 564is locked and/or unlocked in relation to the proximal portion of thesecondary steerable catheter 150 using a pivotable toggle clamp 565.When the clamp collar 564 is locked on the distal portion of thesecondary steerable catheter 150 (by actuating pivotable toggle clamp565 to a locked position), the secondary steerable catheter 150 isprevented by the clamp collar 564 from rotating about its longitudinalaxis. However, when the clamp collar 564 is unlocked in relation to theproximal portion of the secondary steerable catheter 150 (by actuatingpivotable toggle clamp 565 to an unlocked position), the secondarysteerable catheter 150 is free to be rotated about its longitudinalaxis. That is, the proximal portion of the secondary steerable catheter150 is free to be rotated within the clamp collar 564. After actuating adesired rotation of the secondary steerable catheter 150 by rotating theproximal portion of the secondary steerable catheter 150, the pivotabletoggle clamp 565 can be actuated to a locked position to rigidly holdthe secondary steerable catheter 150 in the desired rotational position.

In another example, the proximal portion of the inner catheter 160 isreleasably coupled within a clamp collar 574 of the inner cathetercontrol assembly 570. The clamp collar 574 is locked and/or unlocked inrelation to the proximal portion of the inner catheter 160 using apivotable toggle clamp 575. When the clamp collar 574 is locked on theproximal portion of the inner catheter 160 (by actuating pivotabletoggle clamp 575 to a locked position), the inner catheter 160 isprevented by the clamp collar 574 from rotating about its longitudinalaxis. However, when the clamp collar 574 is unlocked in relation to theproximal portion of the inner catheter 160 (by actuating pivotabletoggle clamp 575 to an unlocked position), the inner catheter 160 isfree to be rotated about its longitudinal axis. That is, the distalportion of the inner catheter 160 is free to be rotated within the clampcollar 574. After actuating a desired rotation of the inner catheter 160by rotating the proximal portion of the inner catheter 160, thepivotable toggle clamp 575 can be actuated to a locked position torigidly hold the inner catheter 160 in the desired rotational position.

In some embodiments, such as the depicted embodiment, one or more (orall, in some embodiments) of the other components of the delivery system100 can be rotationally positioned as desired using the techniquesdescribed above in relation to the secondary steerable catheter 150 andthe inner catheter 160. For example, in the depicted embodiment theguide catheter 120, the anchor delivery sheath 130, and the anchordelivery catheter 140 can be rotationally positioned as desired usingthe techniques described above in relation to the secondary steerablecatheter 150 and the inner catheter 160. In the depicted embodiment, theguidewire control assembly 580 is configured differently than the othercontrol assemblies, nevertheless, the guidewire control assembly 580includes a clamp that can be released to allow for a rotation of theguidewire 110 about its longitudinal axis if so desired.

Still referring to FIGS. 28A-28C, the deployment frame system 500 canalso facilitate a deflection (e.g., a steering or bending) of one ormore portions of a component of the delivery system 100. For example, asdescribed above in reference to FIG. 3, the secondary steerable catheter150 is articulable to facilitate orientation of the anchor assembly 200in relation to the mitral valve 17 as desired. That is, in someembodiments (such as the depicted embodiment) the secondary steerablecatheter 150 (and/or other components of the delivery system 100) hasone or more deflection zones at a distal end portion of the secondarysteerable catheter 150. For example, in the depicted embodiment thesecondary steerable catheter 150 has two deflection zones 152 and 154(refer to FIG. 5) at the distal end portion of the secondary steerablecatheter 150. In the depicted embodiment, the two deflection zones 152and 154 allow for deflection of the distal end portion of the secondarysteerable catheter 150 within two separate and distinct planes.

The secondary steerable catheter control assembly 560 is configured toactuate deflection motions within the two deflection zones 152 and 154of the secondary steerable catheter 150. That is, as seen in FIG. 28C,the secondary steerable catheter control assembly 560 a first deflectionactuator 566 and a second deflection actuator 567. By turning the knobsof the first deflection actuator 566 and the second deflection actuator567, the deflection motions within the two deflection zones 152 and 154of the secondary steerable catheter 150 can be actuated and controlled.In general, each of the deflection zones 152 and 154 includes a collarto which two wires are attached. The two wires are disposed about 180°apart from each other on the collar. The wires run through lumens in thewall of the secondary steerable catheter 150 from the collar to thefirst deflection actuator 566 or the second deflection actuator 567. Arotation of the deflection actuators 566 and 567 tensions one of thewires and relaxes the other wire. Hence, the deflection can be actuatedand controlled.

While in the depicted embodiment the two deflection zones 152 and 154are generally orthogonal to each other, in some embodiments the twodeflection zones 152 and 154 are oriented at angles other than 90° toeach other (e.g., about 70°-90°, or about 60°-80°, or about 50°-70°, orabout 40°-60°, or less than about 40°).

In the depicted embodiment, the guide catheter control assembly 530 isalso configured with a deflection actuator 536 to actuate a deflectionof the guide catheter 102. The guide catheter control assembly 530 alsoincludes a deflection plane orientation indicator 537. It should beunderstood that any of the components of the delivery system 100 can beconfigured to be steerable.

The deployment frame system 500 can also facilitate a tensioning oruntensioning of control wires 142 a and 142 b (such as to control theradial expansion of the anchor assembly 200 as described above inreference to FIGS. 3 and 4). Further description of tensioning oruntensioning of control wires is provided below in reference to FIG. 31.

Still referring to FIGS. 28A-28C, the proximal ends of the catheters andsheaths of the delivery system 100 may include a seal. For example, asseen in FIG. 28C, the proximal end of the secondary steerable catheter150 has a seal 568. The seal 568 functions to inhibit or prevent fluidsfrom exiting the catheter or sheath, and to inhibit or prevent airingress into the catheter or sheath. In some embodiments, one or more ofthe seals may be adjustable to provide varying amounts of sealingpressure.

In the depicted embodiment, the proximal end of the guide catheter 120also includes a flexible zone 538. The flexible zone 538 can be used totemporarily clamp (e.g., with a hemostat device and the like) the guidecatheter 120 substantially closed during and after the removal one ormore of the catheters or sheaths from within the guide catheter 120.This feature may be beneficial, for example, when changing over from thedeployment frame system 500 to the deployment frame system 700 (asdescribed further below) to substantially maintain a seal of guidecatheter 120.

The proximal ends of the catheters and sheaths of the delivery system100 may also include one or more flushing ports. For example, as seen inFIG. 28C, the proximal end of the secondary steerable catheter 150 has aflushing port 569, and the proximal end of the inner catheter 160 has aflushing port 579. Such flushing ports facilitate liquid flushing of therespective catheter or sheath so as to substantially eliminate air fromwithin the catheter or sheath. In some embodiments, one or more of theseals may be adjustable to provide varying amounts of sealing pressure.

In some embodiments, at least one (or both) of the main frame 510 andthe secondary frame 520 include visual indicators thereon. For example,as seen in FIG. 28C, in the depicted embodiment the main frame 510 has aseries of hash marks that serve as a linear scale to assist theclinician with having an understanding of the relative positions of thecomponents of deployment system 100 and of the movements made thereto.In some embodiments, other types of visual indicators are included suchas, but not limited to, dial gauges, digital gauges, numerical scales,indicator lights, labels, color codes, and the like.

Referring to FIG. 31, after the deployment of the anchor assembly 200(as described above in reference to FIGS. 1-7 and 13A-14B), the exampledeployment frame system 500 can be configured to deploy a prostheticmitral valve assembly 300 (refer to FIGS. 15-26) using the transcatheterdelivery system 100. While the depicted deployment frame system 500 isconfigured for deploying the valve assembly 300, it should be understoodthat this context is one illustrative example of how the inventiveconcepts provided herein can be implemented. That is, the inventiveconcepts described in the context of deployment frame system 500 can beadapted and implemented for the percutaneous deployment of many othertypes of prosthetic implants, medical devices, and the like.

In the depicted configuration (which is arranged for deploying the valveassembly 300), deployment frame system 500 includes the main frame 510,the secondary frame 520, the guide catheter control assembly 530, theguidewire control assembly 580, a valve delivery sheath control assembly810, a valve delivery catheter control assembly 820, a first controlwire handle 826, and a second control wire handle 828.

In some implementations, after the deployment of the anchor assembly 200using the deployment frame system 500 in the configuration of FIGS.28A-28C, the deployment frame system 500 can be reconfigured to theconfiguration of the deployment frame system 500 as shown in FIG. 31 forthe deployment of the valve assembly 300. In some exampleimplementations, the steps for reconfiguring the deployment frame system500 from the anchor deployment configuration to the valve deploymentconfiguration are as follows. Referring also to FIG. 28A, the clampcollars of the anchor delivery sheath control assembly 540, the anchordelivery catheter control assembly 550, the secondary steerable cathetercontrol assembly 560, the inner catheter control assembly 570, and theguidewire control assembly 580 can be opened. Then, the anchor deliverysheath 130, the anchor delivery catheter 140, and the secondarysteerable catheter 150 can be pulled back from engagement with the othermembers of the deployment system 100 (while leaving the guide catheter120, inner catheter 160 and guidewire 110 in place). Next the valvedelivery sheath 170 (containing the valve assembly 300 in someimplementations) and the valve delivery catheter 180 can be installedwithin the guide catheter 120 and over the inner catheter 160. The valvedelivery sheath control assembly 810 and the valve delivery cathetercontrol assembly 820 can then be clamped to the main frame 510 and thesecondary frame 520 as shown in FIG. 31. In some implementations, theinner catheter 160 is allowed to float on the guidewire 110 (i.e., insome embodiments no inner catheter control assembly is used, as shown inFIG. 31). In some implementations of the deployment frame system 500 fordeployment of the anchor assembly 200, the inner catheter 160 is allowedto float on the guidewire 110.

In the depicted embodiment, the valve delivery catheter control assembly820 is coupled with the first control wire handle 826, and the secondcontrol wire handle 828.

The first control wire handle 826 and the second control wire handle 828can be used to actuate and control the control wires the one or morecontrol wires of the valve delivery catheter 180. For example, asdescribed in reference to FIG. 19, in some embodiments the valvedelivery catheter 180 includes a first control wire that restrains theproximal end portion of the valve assembly 300, and a second controlwire that restrains the distal end portion of the valve assembly 300. Astension on the first control wire is released, the proximal end portionof the valve assembly 300 is allowed to radially expand. Similarly, astension on the second control wire is released, the distal end portionof the valve assembly 300 is allowed to radially expand. The firstcontrol wire handle 826 and the second control wire handle 828 can beused by the clinician to actuate and control the expansions of theportions of the valve assembly 300 sequentially, concurrently, orpartially concurrently. Such control wire handles 826 and 828 may alsobe included in the anchor assembly deployment configuration of thedeployment frame system 500 (refer to FIGS. 28A-28C) for control of thecontrol wires 142 a and 142 b.

Referring to FIGS. 32-34, additional example embodiments of deploymentframe systems are depicted. It should be understood that one or morefeatures of one example deployment frame system described herein can becombined with one or more features of one or more other exampledeployment frame systems described herein. Accordingly, deployment framesystem hybrid designs can be created which are entirely within the scopeof this disclosure.

FIG. 32 depicts an example deployment frame system 900 that is shown inconjunction with an example catheter system 1000. The deployment framesystem 900 includes a main frame 910, a secondary frame 920, andcatheter control assemblies 930, 940, 950, and 960. The catheter controlassembly 930 is longitudinally slidable in relation to the main frame910. The catheter control assemblies 940, 950, and 960 arelongitudinally slidable in relation to the main frame 910 and thesecondary frame 920. The catheter control assemblies 930, 940, 950, and960 are each individually releasably lockable to the main frame 910. Thecatheter control assemblies 940, 950, and 960 are each individuallyreleasably lockable to the secondary frame 920. In the depictedembodiment, the deployment frame system 900 includes a support structure901 which orients the main frame 910 and the secondary frame 920 at anacute angle in relation to horizontal. In some embodiments, the acuteangle is selectively adjustable.

FIG. 33 depicts another example deployment frame system 1100 that isshown in conjunction with an example catheter system 1200. Thedeployment frame system 1100 includes a main frame 1110, a secondaryframe 1120, and catheter control assemblies 1130, 1140, 1150, and 1160.The catheter control assembly 1130 is longitudinally slidable inrelation to the main frame 1110. In some embodiments, the cathetercontrol assemblies 1140, 1150, and 1160 are longitudinally slidable inrelation to the main frame 1110 and the secondary frame 1120. In someembodiments, the catheter control assemblies 1130, 1140, 1150, and 1160are each individually releasably lockable to the main frame 1110. Thecatheter control assemblies 1140, 1150, and 1160 are each individuallyreleasably lockable to the secondary frame 1120. In the depictedembodiment, the deployment frame system 1100 includes a supportstructure 1101 which orients the main frame 1110 and the secondary frame1120 at an acute angle in relation to horizontal. In some embodiments,the acute angle is selectively adjustable.

In the depicted embodiment of the deployment frame system 1100, thesecondary frame 1120 is slidably disposed on top of a portion of themain frame 1110. Hence, in this embodiment the main and secondary framesare not spaced apart, horizontally side-by-side as in some otherdeployment frame system embodiments described herein. In someembodiments, the arrangement of the deployment frame system 1100 withthe secondary frame 1120 slidably disposed on top of a portion of themain frame 1110 may provide for a more compact configuration than somespaced apart, horizontally side-by-side deployment frame systemconfigurations.

FIG. 34 depicts another example deployment frame system 1300 that isshown in conjunction with an example catheter system 1400. Thedeployment frame system 1300 includes a main frame 1310, a secondaryframe 1320, and catheter control assemblies 1330, 1340, and 1350. Inthis embodiment, the control assemblies of two catheters are combinedinto the single catheter control assembly 1340. The catheter controlassembly 1330 is longitudinally slidable in relation to the main frame1310. In some embodiments, the catheter control assemblies 1340 and 1350are longitudinally slidable in relation to the main frame 1310 and thesecondary frame 1320. In some embodiments, the catheter controlassemblies 1330, 1340, and 1350 are each individually releasablylockable to the main frame 1310. In some embodiments, the cathetercontrol assemblies 1340 and 1350 are each individually releasablylockable to the secondary frame 1320. In the depicted embodiment, thedeployment frame system 1300 includes a support structure 1301 whichorients the main frame 1310 and the secondary frame 1320 at an acuteangle in relation to horizontal. In some embodiments, the acute angle isselectively adjustable.

In the depicted embodiment of the deployment frame system 1300, thesecondary frame 1320 is slidably disposed on top of a portion of themain frame 1310. Hence, in this embodiment the main and secondary framesare not spaced apart, horizontally side-by-side as in some otherdeployment frame system embodiments described herein. In someembodiments, the arrangement of the deployment frame system 1300 withthe secondary frame 1320 slidably disposed on top of a portion of themain frame 1310 may provide for a more compact configuration than somespaced apart, horizontally side-by-side deployment frame systemconfigurations. In the depicted embodiment, a locking device 1303 isincluded that can releasably lock the secondary frame 1320 and the mainframe 1310 together.

FIG. 35 depicts another example deployment frame system 1500. Thedeployment frame system 1500 is shown in conjunction with an examplecatheter system 1600. In the depicted embodiment, the deployment framesystem 1500 is configured to be able to percutaneously deploy a devicesuch as the anchor assembly 200 described above. In such a case, thecatheter system 1600 can be configured like the delivery system 100described above (i.e., a guidewire 110, a guide catheter 120, an anchordelivery sheath 130, an anchor delivery catheter 140, a secondarysteerable catheter 150, and an inner catheter 160).

In the depicted configuration, the deployment frame system 1500 includesa main frame 1510, a secondary frame 1520, and a support structure 1501.The main frame 1510 can be releasably coupled to the support structure1501. That is, in some embodiments the main frame 1510 can be detachedfrom the support structure 1501. In some such embodiments, the mainframe 1510 is a single-use component, while the support structure 1501is a sterilizable, reusable component. While in use, the main frame 1510remains stationary in relation to the support structure 1501. In someembodiments, the main frame 1510 is a portion of the support structure1501.

In the depicted embodiment, the secondary frame 1520 is an invertedu-channel that is slidably coupled directly on the main frame 1510.Other arrangements can also be used (e.g., side-by-side, etc.). Thesecondary frame 1520 can be selectively longitudinally translated(proximally and distally) in relation to the main frame 1510. In thedepicted embodiment, the secondary frame 1520 includes a frame clampassembly 1522 disposed at a distal end of the second frame 1520. Theframe clamp assembly 1522 is releasably clampable at any position alongthe main frame 1510. That is, the frame clamp assembly 1522 is slidablealong the main frame 1510 (along with the rest of the secondary frame1520) while the frame clamp assembly 1522 is unclamped from the mainframe 1510, and the frame clamp assembly 1522 will be held stationary inrelation to the main frame 1510 while the frame clamp assembly 1522 isclamped to the main frame 1510. In the depicted embodiment, a pivotabletoggle clamp 1523 is used to manually clamp and unclamp the frame clampassembly 1522 (and the secondary frame 1520 as a whole) to the mainframe 1510. With toggle clamp 1523 unclamped, the secondary frame 1520is free to translate proximally and distally in relation to the mainframe 1510.

In the depicted embodiment, the frame clamp assembly 1522 also includesa latch mechanism 1524. The latch mechanism 1524 can be manuallyactuated to facilitate the complete detachment of the secondary frame1520 from the main frame 1510. In other words, when the latch mechanism1524 is actuated (e.g., the button(s) is/are pressed) the secondaryframe 1520 can be separated from its engagement with the main frame1510. This functionality can be advantageous, for example, whenconverting from the arrangement of FIG. 35 to the arrangement of FIG.36, as described further below. The latch mechanism 1524 can bespring-biased such that its default arrangement (i.e., while unactuated)is to be latched to the main frame 1510.

The deployment frame system 1500 also includes a guide catheter controlassembly 1530, an anchor delivery sheath control assembly 1540, ananchor delivery catheter control assembly 1550, and a secondarysteerable catheter control assembly 1560. The guide catheter 120 extendsthrough the guide catheter control assembly 1530 and terminates at aguide catheter seal device 1538. A proximal end of the anchor deliverysheath 130 is terminated at the anchor delivery sheath control assembly1540. A proximal end of the anchor delivery catheter 140 is terminatedat the anchor delivery catheter control assembly 1550. A proximal end ofthe secondary steerable catheter 150 is terminated at the secondarysteerable catheter control assembly 1560.

In the depicted embodiment, the proximal end of the inner catheter 160is “floating” on the guidewire 110. That is, the inner catheter 160 andguidewire 110 are not terminated at a control assembly that is coupledto the main frame 1510 or the secondary frame 1520. In some embodiments,control assemblies for one or both of the inner catheter 160 andguidewire 110 are included such that the inner catheter 160 and/orguidewire 110 are terminated at a control assembly that is coupled tothe main frame 1510, or the secondary frame 1520, or both.

The guide catheter control assembly 1530 is releasably clampable to themain frame 1510. A pivotable toggle clamp 1533 is actuatable whereby theguide catheter control assembly 1530 can be selectively clamped andunclamped in relation to the main frame 1510. While the toggle clamp1533 is oriented such that the guide catheter control assembly 1530 isunclamped in relation to the main frame 1510, the guide catheter controlassembly 1530 can be translated distally and proximally along thelongitudinal axis of the main frame 1510. While the toggle clamp 1533 isoriented such that the guide catheter control assembly 1530 is clampedin relation to the main frame 1510, the guide catheter control assembly1530 is detained from being translated distally and proximally along thelongitudinal axis of the main frame 1510.

In the depicted embodiment, the guide catheter control assembly 1530also includes a latch mechanism 1534. The latch mechanism 1534 can bemanually actuated to facilitate the detachment of the guide cathetercontrol assembly 1530 from the main frame 1510. In other words, when thelatch mechanism 1534 is actuated (e.g., the button(s) is/are pressed)the guide catheter control assembly 1530 can be separated from itsengagement with the main frame 1510. The latch mechanism 1534 can bespring-biased such that its default arrangement (i.e., while unactuated)is to be latched to the main frame 1510.

In the depicted embodiment, the anchor delivery sheath control assembly1540 is releasably clampable to the main frame 1510 and to the secondaryframe 1520. A pivotable toggle clamp 1543 is actuatable whereby theanchor delivery sheath control assembly 1540 can be selectively clampedand unclamped in relation to the main frame 1510. In addition, theanchor delivery sheath control assembly 1540 includes a latch mechanism1544. The latch mechanism 1544 is actuatable such that the anchordelivery sheath control assembly 1540 can be selectively clamped andunclamped in relation to the secondary frame 1520. In the depictedarrangement, the latch mechanism 1544 is in the clamped position. Bysliding the knob of the latch mechanism 1544 upward (i.e., away from thesecondary frame 1520), the anchor delivery sheath control assembly 1540will become unclamped from the secondary frame 1520.

In the depicted embodiment, the anchor delivery catheter controlassembly 1550 is releasably clampable to the secondary frame 1520.However, in the depicted embodiment the anchor delivery catheter controlassembly 1550 is not clampable to the main frame 1510. In someembodiments, the anchor delivery catheter control assembly 1550 isreleasably clampable to the main frame 1510. The anchor deliverycatheter control assembly 1550 includes a latch mechanism 1554. Thelatch mechanism 1554 is actuatable such that the anchor deliverycatheter control assembly 1550 can be selectively clamped and unclampedin relation to the secondary frame 1520. In the depicted arrangement,the latch mechanism 1554 is in the clamped position. By sliding the knobof the latch mechanism 1554 away from the secondary frame 1520, theanchor delivery catheter control assembly 1550 will become unclampedfrom the secondary frame 1520 such that the anchor delivery cathetercontrol assembly 1550 can be translated proximally and distally alongthe axes of the main frame 1510 and the secondary frame 1520.

In the depicted embodiment, the secondary steerable catheter controlassembly 1560 is releasably clampable to the secondary frame 1520.However, in the depicted embodiment the secondary steerable cathetercontrol assembly 1560 is not clampable to the main frame 1510. In someembodiments, the secondary steerable catheter control assembly 1560 isreleasably clampable to the main frame 1510. The secondary steerablecatheter control assembly 1560 includes a latch mechanism 1564. Thelatch mechanism 1564 is actuatable such that the secondary steerablecatheter control assembly 1560 can be selectively clamped and unclampedin relation to the secondary frame 1520. In the depicted arrangement,the latch mechanism 1564 is in the clamped position. By sliding the knobof the latch mechanism 1564 away from the secondary frame 1520, thesecondary steerable catheter control assembly 1560 will become unclampedfrom the secondary frame 1520 such that the secondary steerable cathetercontrol assembly 1560 can be translated proximally and distally alongthe axes of the main frame 1510 and the secondary frame 1520.

As described above, such as in reference to FIGS. 29A-30B, the toggleclamps 1533, 1523, and 1543 and the latch mechanisms 1544, 1554, and1564 can be selectively clamped and/or unclamped to facilitatelongitudinal translations in the proximal and distal directions of asingle one of the guide catheter control assembly 1530, the anchordelivery sheath control assembly 1540, the anchor delivery cathetercontrol assembly 1550, or the secondary steerable catheter controlassembly 1560, or of multiple ones of the guide catheter controlassembly 1530, the anchor delivery sheath control assembly 1540, theanchor delivery catheter control assembly 1550, and the secondarysteerable catheter control assembly 1560 synchronously. In one exampleof synchronous translation, while the toggle clamps 1523 and 1543 areunclamped and the toggle clamp 1533 and the latch mechanisms 1544, 1554,and 1564 are clamped, the anchor delivery sheath control assembly 1540,the anchor delivery catheter control assembly 1550, and the secondarysteerable catheter control assembly 1560 can be synchronously translatedproximally and distally by sliding the secondary frame 1520 along themain frame 1510.

In the depicted embodiment of the deployment frame system 1500, each ofthe catheter control assemblies 1530, 1540, 1550, and 1560 can beindividually selectively actuated to allow rotation of the catheter thatis terminated at the respective control assembly 1530, 1540, 1550, or1560. For example, the guide catheter control assembly 1530 includes alatch mechanism 1535 that can be manually actuated to allow the guidecatheter 120 to be manually rotated about its longitudinal axis whilethe other components of the catheter system 1600 are held stationary bylatch mechanisms 1545, 1555, and 1565 such that they do not rotate. Inthe depicted embodiment, the latch mechanism 1535 includes a button thatcan be depressed to unlatch the guide catheter 120 so it can be rotated.The button of the latch mechanism 1535 can be spring-biased to thelatched configuration such that releasing the button latches the guidecatheter 120 to prevent its rotation. The other latch mechanisms 1545,1555, and 1565 can function analogously to that of the latch mechanism1535.

As described above, some components of the catheter systems describedherein can include one or more deflection zones that are controllablydeflectable. For example, the distal end portion of the guide catheter120 can be deflected to navigate the patient's anatomy and/or to bepositioned in relation to the patient's anatomy as desired.Additionally, the secondary steerable catheter 150 has two deflectionzones 152 and 154 (refer to FIG. 5) at the distal end portion of thesecondary steerable catheter 150. In some embodiments, the twodeflection zones 152 and 154 allow for deflection of the distal endportion of the secondary steerable catheter 150 within two separate anddistinct planes.

The deployment frame system 1500 is also configured to allow a clinicianto controllably deflect some components of the catheter system 1600. Forexample, the guide catheter control assembly 1530 includes a rotarydeflection actuator 1536 that can be manually rotated to control thedeflection of the distal end portion of the guide catheter 120.Additionally, the secondary steerable catheter control assembly 1560includes a first deflection actuator 1566 and a second rotary deflectionactuator 1567 that can be manually rotated to control the deflection ofthe deflection zones 152 and 154 at the distal end portion of thesecondary steerable catheter 150.

In some embodiments, catheter control assemblies that include one ormore rotary deflection actuators (e.g., catheter control assemblies 1530and 1560) can include visual indicators to provide clinicians with avisual indication of how much the respective catheter is deflected. Forexample, the guide catheter control assembly 1530 includes a deflectionindicator 1537. The deflection indicator 1537 includes a window and atranslating marker that act together like a gauge to provide a visualindication of how much the guide catheter 120 is deflected. Similarly,the secondary steerable catheter control assembly 1560 includes a firstdeflection indicator 1568 and a second deflection indicator 1569 thatprovide a visual indication of how much the deflection zones 152 and 154at the distal end portion of the secondary steerable catheter 150 aredeflected.

The deployment frame system 1500 is also configured to allow a clinicianto make adjustments to the tension of the control wires of the cathetersystem 1600. For example, as described above in reference to FIG. 2, insome embodiments one or more portions of the anchor assembly 200 can bereleasably coupled to the anchor delivery catheter 140 by two controlwires 142. In one such example, one of the two control wires 142 isreleasably coupled with a proximal end of the anchor assembly 200, and asecond of the two control wires 142 is releasably coupled with amid-body portion of the anchor assembly 200. A clinician can separatelycontrol the two control wires 142 using a first control wire adjustmentassembly 1556 and a second control wire adjustment assembly 1557. In thedepicted embodiment, the ends of the control wires 142 are fixedlyterminated at the proximal ends of the control wire adjustmentassemblies 1556, 1557. Then, to add tension to or to release tensionfrom the control wires 142, the proximal ends of the control wireadjustment assemblies 1556, 1557 can be translated proximally ordistally, respectively, in relation to the anchor delivery cathetercontrol assembly 1550. In the depicted embodiment, the control wireadjustment assemblies 1556, 1557 each include a latch mechanism 1558,1559, respectively. The latch mechanisms 1558, 1559 can be used todetain the proximal ends of the control wire adjustment assemblies 1556,1557 in a desired orientation in relation to the anchor deliverycatheter control assembly 1550 such that the desired tension of therespective control wire is releasably maintained.

FIG. 36 depicts another example deployment frame system 1700. Thedeployment frame system 1700 is shown in conjunction with an examplecatheter system 1800. In the depicted embodiment, the deployment framesystem 1700 is configured to be able to percutaneously deploy a devicesuch as the valve assembly 300 described above. In such a case, thecatheter system 1800 can be configured like the delivery system 100described above (i.e., a guidewire 110, a guide catheter 120, an innercatheter 160, a valve delivery sheath 170, and a valve delivery catheter180).

In the depicted configuration, the deployment frame system 1700 includesthe main frame 1510 (which may be the same main frame 1510 used for thedeployment frame system 1500 described above), a secondary frame 1720,and the support structure 1501 (which may be the same support structure1501 used for the deployment frame system 1500 described above). A frameclamp assembly 1722 selectively clamps the secondary frame 1720 to themain frame 1510.

To convert from the deployment frame system 1500 (e.g., after thedeployment of the anchor assembly 200) to the deployment frame system1700 (to prepare for the deployment of the valve assembly 300), in somecases a clinician may take the following steps. The toggle clamps 1523and 1543 can be unclamped from the main frame 1510. The latch mechanism1524 of the secondary frame clamp assembly 1522 can be actuated tounlatch the secondary frame 1520 from the main frame 1510. With theclamps 1523 and 1543 unclamped, and the latch mechanism 1524 actuated,the secondary frame 1520 (along with the attached catheter controlassemblies 1540, 1550, and 1560 and their respective components of thecatheter system 1600) can be pulled proximally off of the main frame1510. The proximal movement of the secondary frame 1520 and itsassociated components can be continued until the anchor delivery sheath130, anchor delivery catheter 140, and the secondary steerable catheter150 have been fully disengaged from the guide catheter 120, the innercatheter 160, and the guidewire 110.

In order to inhibit or substantially prevent fluids from exiting theguide catheter 120 resulting from the removal of anchor delivery sheath130, anchor delivery catheter 140, and the secondary steerable catheter150, and/or to inhibit or substantially prevent air ingress into theguide catheter 120 resulting from the removal of anchor delivery sheath130, anchor delivery catheter 140, and the secondary steerable catheter150, the guide catheter seal device 1538 can be used to seal theproximal end of the guide catheter 120. Next, the valve delivery sheath170 (which can be preloaded with the prosthetic valve assembly 300) andthe valve delivery catheter 180 can be threaded over the inner catheter160 and the guidewire 110, and into the guide catheter 120. Thesecondary frame 1720 can be engaged with the main frame 1510, and avalve delivery sheath control assembly 1730 and a valve deliverycatheter control assembly 1740 can be engaged with the secondary frame1720. The sequence of the actions performed to convert from thearrangement of FIG. 35 to the arrangement of FIG. 36 may be performed indiffering orders without departing from the inventive scope of thisdisclosure.

The deployment frame system 1700 also includes the valve delivery sheathcontrol assembly 1730 and the valve delivery catheter control assembly1740. The proximal end of the valve delivery sheath 170 is terminated atthe valve delivery sheath control assembly 1730. The proximal end of thevalve delivery catheter 180 is terminated at the valve delivery cathetercontrol assembly 1740.

In the depicted embodiment, the valve delivery sheath control assembly1730 and the valve delivery catheter control assembly 1740 areconfigured similarly in that each is releasably clampable to thesecondary frame 1720, but not to the main frame 1510. In particular, thevalve delivery sheath control assembly 1730 includes a latch mechanism1731 and the valve delivery catheter control assembly 1740 includes alatch mechanism 1741. The latch mechanisms 1731 and 1741 releasablyclamp the valve delivery sheath control assembly 1730 and the valvedelivery catheter control assembly 1740, respectively, at selectedlocations along the longitudinal axis of the secondary frame 1720.Further, the valve delivery sheath control assembly 1730 includes alatch mechanism 1732 and the valve delivery catheter control assembly1740 includes a latch mechanism 1742. The latch mechanisms 1732 and 1742releasably clamp and prevent rotation of the valve delivery sheath 170and the valve delivery catheter 180, respectively. Manual actuation ofthe latch mechanism 1732 allows the valve delivery sheath 170 to bemanually rotated about its longitudinal axis while the other componentsof the catheter system 1800 are held stationary by latch mechanisms 1535and 1742 such that they do not rotate. Similarly, manual actuation ofthe latch mechanism 1742 allows the valve delivery catheter 180 to bemanually rotated about its longitudinal axis while the other componentsof the catheter system 1800 are held stationary by latch mechanisms 1535and 1732 such that they do not rotate.

The deployment frame system 1700 is also configured to allow a clinicianto make adjustments to the tension of the control wires of the cathetersystem 1800. For example, as described above in reference to FIG. 18, insome embodiments one or more portions of the valve assembly 300 can bereleasably coupled to the valve delivery catheter 180 by control wires.In one such example, one of two control wires is releasably coupled witha proximal end of the valve assembly 300, and a second of the twocontrol wires is releasably coupled with a distal end of the valveassembly 300. A clinician can separately control the two control wiresusing a first control wire adjustment assembly 1746 and a second controlwire adjustment assembly 1747. In the depicted embodiment, the ends ofthe control wires are fixedly terminated at the proximal ends of thecontrol wire adjustment assemblies 1746, 1747. Then, to add tension toor to release tension from the control wires, the proximal ends of thecontrol wire adjustment assemblies 1746, 1747 can be translatedproximally or distally, respectively, in relation to the valve deliverycatheter control assembly 1740. In the depicted embodiment, the controlwire adjustment assemblies 1746, 1747 each include a latch mechanism1748, 1749, respectively. The latch mechanisms 1748, 1749 can be used todetain the proximal ends of the control wire adjustment assemblies 1746,1747 in a desired orientation in relation to the valve delivery cathetercontrol assembly 1740 such that the desired tension of the respectivecontrol wire is releasably maintained.

A number of embodiments of the invention have been described.Nevertheless, it will be understood that various modifications may bemade without departing from the scope of the invention. Accordingly,other embodiments are within the scope of the following claims.

What is claimed is:
 1. A deployment frame system for controllingrelative movements of a system of multiple catheters wherein at leastone catheter of the multiple catheters is configured to deliver amedical device, the deployment frame system comprising: a plurality ofclamps, each of the clamps configured to releasably clamp a proximal endportion of a respective catheter of the multiple catheters; a firstframe, wherein at least one of the clamps is releasably coupled with thefirst frame; and a second frame, wherein at least two of the clamps isreleasably coupled with the second frame.
 2. The deployment frame systemof claim 1, wherein the second frame is translatable parallel to alongitudinal axis of the first frame.
 3. The deployment frame system ofclaim 2, further comprising a frame clamp mechanism whereby the secondframe is clampable to the first frame at a plurality of relativelongitudinal orientations between the first frame and the second frame.4. The deployment frame system of claim 1, wherein unclamping arespective one of the clamps from a respective catheter allows therespective catheter to be rotated about a longitudinal axis of therespective catheter.
 5. The deployment frame system of claim 1, whereinat least one of the clamps is configured to releasably clamp onto thefirst frame and onto the second frame simultaneously.
 6. The deploymentframe system of claim 1, wherein at least one of the clamps includes anactuator for deflecting a portion of a respective catheter while therespective catheter is clamped by the clamp.
 7. The deployment framesystem of claim 1, wherein at least one of the clamps includes amechanism for selectively adding and removing tension from one or morecontrol wires.
 8. A medical device deployment system comprising: asystem of multiple catheters configured to deliver a medical device,wherein at least some catheters of the multiple catheters are slidablyengageable with each other, wherein at least one catheter of themultiple catheters is releasably coupleable with the medical device; anda deployment frame system comprising: a plurality of clamps, each of theclamps configured to releasably clamp a proximal end portion of arespective catheter of the multiple catheters; a first frame, wherein atleast one of the clamps is configured to releasably couple with thefirst frame; and a second frame, wherein at least two of the clamps areconfigured to releasably couple with the second frame.
 9. The system ofclaim 8, further comprising one or more control wires extending througha catheter of the multiple catheters and configured to releasably couplewith the medical device.
 10. The system of claim 9, wherein at least oneof the clamps includes a mechanism for selectively adjusting a tensionof the one or more control wires.
 11. The system of claim 8, whereineach of the clamps is configured to slidably engage with the firstframe.
 12. The system of claim 8, wherein at least one of the clamps isconfigured to releasably clamp onto the first frame and onto the secondframe simultaneously.
 13. The system of claim 8, wherein each catheterthat is releasably clamped to a clamp is rotatable, in relation theclamp, about a longitudinal axis of the catheter.
 14. The system ofclaim 8, further comprising a frame clamp mechanism whereby the secondframe is clampable to the first frame at a plurality of relativelongitudinal orientations between the first frame and the second frame.15. The system of claim 8, wherein two or more of the clamps areclampable to the second frame and are free to translate along the firstframe such that a translational movement of the second frame relative tothe first frame simultaneously moves the two or more clamps in relationto the first frame.
 16. The system of claim 15, wherein thetranslational movement of the second frame causes correspondingsimultaneous movements of two or more catheters of the multiplecatheters.
 17. A prosthetic mitral valve and deployment system,comprising: a prosthetic mitral valve; a system of multiple cathetersconfigured to deliver the prosthetic mitral valve, wherein at least somecatheters of the multiple catheters are slidably engageable with eachother, wherein one or more catheters of the multiple catheters arereleasably coupleable to the prosthetic mitral valve; and a deploymentframe system comprising: a plurality of clamps, each of the clampsconfigured to releasably clamp a proximal end portion of a respectivecatheter of the multiple catheters; a first frame, wherein at least oneof the clamps is configured to releasably couple with the first frame;and a second frame, wherein at least two of the clamps are configured toreleasably couple with the second frame.
 18. The prosthetic mitral valveand deployment system of claim 17, wherein the prosthetic mitral valvecomprises a hub, and wherein a first catheter of the multiple cathetersis releasably coupleable to the hub.
 19. The prosthetic mitral valve anddeployment system of claim 17, further comprising one or more controlwires extending through a catheter of the multiple catheters andconfigured to releasably couple with the medical device.
 20. Theprosthetic mitral valve and deployment system of claim 19, wherein atleast one of the clamps includes a mechanism for selectively adjusting atension of the one or more control wires, and wherein a diameter of themedical device is controllable by the tension adjustments.